World Journal of Endocrine Surgery

Register      Login

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

RESEARCH ARTICLE

Accuracy and Role of Surgeon-performed Intraoperative Ultrasound in Minimally Invasive Open Parathyroidectomy

Andreas Kiriakopoulos, Dimitrios Linos

Citation Information : Kiriakopoulos A, Linos D. Accuracy and Role of Surgeon-performed Intraoperative Ultrasound in Minimally Invasive Open Parathyroidectomy. World J Endoc Surg 2009; 1 (1):23-26.

DOI: 10.5005/jp-journals-10002-1005

Published Online: 01-12-2009

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


Abstract

Background

Assessment of the accuracy and the role of surgeon-performed ultrasound in comparison to expert radiology-performed ultrasound, sestamibi scanning and histologic findings.

Methods

From January 2006 to December 2007 we prospectively evaluated forty-two consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism. One surgeon who was unaware of the preoperative imaging studies did all ultrasound examinations just prior to skin incision. The correlations between surgeon-performed ultrasound, radiology-expert ultrasound, sestamibi scanning and histologic findings were assessed.

Results

There were thirty-eight females (mean age: 55.9 years, range: 13-83) and four males (mean age: 41 years, range: 42-77) with biochemical evidence of primary hyperparathyroidism. Single gland disease (SGD) was histologically confirmed in thirty-six cases (85.7%) and multigland disease (MGD) in six cases (14.3%). Concordant preoperative U/S and sestamibi findings were found in thirty- four cases in SGD patients: surgeon performed U/S and expert radiology U/S were equally correct in all of these cases. In the rest two discordant cases in SGD patients, radiologist U/S was wrong in both cases, whereas sestamibi and surgeon U/S had no false results. Multigland disease had been predicted by negative findings in preoperative U/S and sestamibi in four patients and by finding more than one enlarged parathyroid glands in two patients. Surgeon U/S gave one false result in the former subgroup of MGD patients, although correctly identified multiple gland enlargements in the latter subgroup.

Conclusions

This study shows that surgeon-performed ultrasound compares favourably and even exceeds radiology U/S. Since this positive predictive result applies especially in SGD, intraoperative U/S had been added in the standards of care of patients with primary hyperparathyroidism in our institution


PDF Share
  1. One hundred consecutive minimally invasive parathyroid explorations Ann Surg 2003;232:331-39.
  2. Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring Br J Surg 2007;94:315-19.
  3. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience Arch Surg 2005;140:472-78.
  4. How should patients with primary hyperparathy-roidism be treated? J Clin Endocrin Metab 2003;88:3011-14.
  5. Minimally invasive parathyroidectomy for primary hyperparathyroidism: Decreasing operative time and potential complications while improving cosmetic results Am Surg 1998;64:391-95.
  6. Minimally invasive procedure for resection of a parathyroid adenoma: The role of high-resolution ultrasonography J Clin Ultrasound 2005;33:283-87.
  7. Parathyroid sonography: Imaging and intervention J Clin Ultrasound 2007;35:144-55.
  8. Sonography of the thyroid and parathyroid glands. Radiol Clin North Am 2000;38:1131-45.
  9. Ultrasound examination of the parathyroid glands. Otolaryngol Clin North Am 2004;37:763-68.
  10. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: Comparison with 99m Tc sestamibi scintigraphy Clin Endocrinol 2002;57:241-49.
  11. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi substraction, double phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT J Nucl Med 1997;37:834-49.
  12. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely on surgeon's choice of operative procedure J Am Coll Surg 1998;186:293-305.
  13. Accuracy of surgeon performed ultrasound in parathyroid localization World J Surg 2004;28:1122-26.
  14. Minimally invasive parathyroidectomy using surgeon-performed ultrasound and sestamibi ANZ J Surg 2007;77:774-77.
  15. Surgeon-performed ultrasound for preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism World J Surg 2006;30:1658-63.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.