Is bilateral exploration still the standard of care for primary hyperparathyroidism?: Outcomes of focused radio-guided parathyroidectomy and bilateral explorations

摘要

BACKGROUND Primary hyperparathyroidism (HPT) is a relatively common surgical disease caused principally by single-gland enlargement and hyperfunction. In experienced hands, 95% of patients are rendered normocalcemic after parathyroidectomy, with minimal morbidity. Traditionally, a bilateral neck exploration (BNE) is the technique of choice. However, new methods are continually being explored to further increase the success rate and decrease the morbidity, including intraoperative ultrasonography, methylene blue localization, selective venous sampling, intraoperative intact parathyroid hormone monitoring, sestamibi scanning, four-dimensional computed tomography, and the use of radio guidance.2 In this Triological Society Best Practice review, we examined the evidence regarding the use of intraoperative radio guidance for parathyroidectomy in primary HPT compared to the use of the traditional BNE procedure. LITERATURE REVIEW Recently, there have been multiple studies examining the use of minimally invasive radio-guided parathyroidectomy (MIRP) for the treatment of primary HPT (see Supporting Table I). The authors of this study reviewed the contemporary literature investigating both MIRP and BNE and performed statistical analysis to determine if there was any advantage of one technique. BNE has been the standard approach for patients with primary HPT. In 2007, Allendorf et al. published a report examining 1,112 cases in which patients underwent BNE for primary HPT. The overall cure rate was reported at 97.4%, with a complication rate of 3.4%.