World Journal of Endocrine Surgery

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VOLUME 1 , ISSUE 1 ( September-December, 2009 ) > List of Articles

RESEARCH ARTICLE

Surgeon-performed Ultrasound in Preoperative Parathyroid Localization: The Cutting Edge of Endocrine Surgeon

MA Yahya, K Normayah, AN Hisham

Citation Information : Yahya M, Normayah K, Hisham A. Surgeon-performed Ultrasound in Preoperative Parathyroid Localization: The Cutting Edge of Endocrine Surgeon. World J Endoc Surg 2009; 1 (1):19-22.

DOI: 10.5005/jp-journals-10002-1004

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Over the years surgery for primary hyperparathyroidism has evolved from bilateral neck exploration to focus unilateral approach. This has been made possible by the advancement in localization technique and availability of the preoperative imaging. This study aimed to determine the feasibility and accuracy of focus unilateral neck approach for primary hyperparathyroidism with surgeon- performed ultrasound as the main decisive preoperative localization imaging technique.

Method

The decision of focus unilateral approach was stipulated if an enlarged parathyroid adenoma was confidently seen in the preoperative localization by surgeon-performed ultrasound. The focus unilateral exploration was terminated if the diseased gland was found. Nonetheless if in doubt, the exploration was extended to include the opposite side of the neck. More importantly any negative preoperative ultrasound will be considered for bilateral neck exploration.

Results

118 consecutive patients were accrued in this study, 76 females and 42 males with mean age of 50 years. Focus unilateral neck exploration was performed on 86 (72.9%) patients and 96.5% of them were successfully explored and cured. 13 (13.1%) patients had exploration of both sides of the neck although the initial decision was only to explore one side. The overall cure rate was 93.2% with the sensitivity and specificity of ultrasound were 78.3% and 95.1% respectively.

Conclusion

Surgeon-performed ultrasound in parathyroid localization in coupled with focus unilateral approach in primary HPT can be performed 73% of patients with a success rate of more than 96%.


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  1. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665-72.
  2. Physiology of the parathyroid glands and pathophysiology of primary hyperparathyroidism. In: Schwartz AE, Pertsemlidis D, Gagner M (Eds) Endocrine Surgery. New York: Marcel Dekker Inc 2004;213-30.
  3. Thyroid and parathyroid. In: Schwarts SJ (Ed) Principles of Surgery. New York: McGraw-Hill 1989;1613-85.
  4. Surgical management of primary hyperparathyroidism. Curr Probl Surg 1985;22:1-50.
  5. Unilateral para- thyroidectomy in hyperparathyroidism due to a single adenoma. Ann Surg 1982;195:245.
  6. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 2005;140(5):472-79.
  7. Parathyroid glands: Combination of 99mTc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393-402.
  8. Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors. World J Surg 1986;10:579-85.
  9. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med 1998;39:320-24.
  10. Abnormal parathyroid glands: High-resolution MR imaging. Radiology 1987;162:487-91.
  11. Parathyroid hormone venous sampling before reoperative surgery in renal hyperparathyroidism: Comparison with non-invasive localisation procedures and review of the literature. Arch Surg 2004;139:1331-38.
  12. Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 2004;28(11):1122-26.
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