PREOPERATIVE PARATHYROID LOCALIZATION WITH SESTAMİBİ AND MINIMAL INVASIVE PARATHYROIDECTOMY: OUR FIRST RESULTS
Dr. Koray ATİLA1, Dr. Mehmet Ali KOÇDOR1, Dr. Ali İbrahim SEVİNÇ1, Dr. Recep BEKİŞ2, Dr. Abdurrahman ÇÖMLEKÇİ3, Dr. Şerafettin CANDA4, Dr. Serdar SAYDAM1, Dr. Ömer HARMANCIOĞLU1
1Dokuz Eylül Üniversitesi Tıp Fakültesi Genel Cerrahi AD, İzmir
2Dokuz Eylül Üniversitesi Tıp Fakültesi Nükleer Tıp AD, İzmir
3Dokuz Eylül Üniversitesi Tıp Fakültesi Endokrinoloji ve Metabolizma AD, İzmir
4Dokuz Eylül Üniversitesi Tıp Fakültesi Patoloji AD, İzmir
Abstract
Aims: The aim of this study is to reach a procedure as effective as complete exploration and reduction of operation duration by minimally invasive approach after detection of the location and number of diseased parathyroid glands with intraoperative sestamibi nuclear mapping in primary hyperparathyroidism patients. Background: Adenoma can be detected in minimally invasive parathyroidectomy by dissection facilitated with intraoperative radioactive gamma detector after sestamibi imaging, and this approach allows us direct handling with smaller incision.
Methods: Between September 2001 - June 2003, 19 patients from 21 of all which were proven biochemically and with sestamibi imaging to be having one parathyroid adenoma were undergone minimally invasive parathyroidectomy under general anesthesia by the mean of a prospective study.
Results: Bilateral standart neck dissection were subsequently performed in two cases. 19 of 21 patients (90,4%) mean ages of 61 (43-79) having one parathyroid adenoma underwent minimally invasive parathyriodectomy facilitated by gamma detector and 2 patients (9,6%) underwent standart neck exploration. Mean serum calcium concentrations were 11,4 mg/dl and 8,3 mg/dl preoperatively and postoperative 12th hours respectively. Mean parathyroid hormone concentrations were 271 pg/ml and 51,3 pg/ml preoperatively and postoperative 15th minutes respectively. Mean radioactivity counts detected by gamma counter were 4340 counts/sec. at the parathyroid adenoma location, 1560 counts/sec. at the operation site after removal of the adenoma and 3460 counts/sec. at the diseased gland. Mean operation duration was 41 (35-70) minutes and mean hospital stay was 2,07 (1-3) days for 19 patients undergone minimally invasive parathyroidectomy.
Conclusion: Minimally invasive approach facilitated with intraopertive sestamibi nuclear mapping is effective and sufficient approach in properly selected hyperparathyroidism patients.
Keywords: Minimally invasive parathyroidectomy, primary hyperparathyroidism, parathyroid adenoma.