EVALUATING THE COMBINED APPROACH OF THREE INTRA-OPERATIVE ADJUNCTS IN LOCALIZING PARATHYROID ADENOMAS DURING MINIMALLY INVASIVE RADIOGUIDED PARATHYROIDECTOMY - A SINGLE CENTRE RETROSPECTIVE ANALYSIS

AUTHORS:
H. Al Harthi (Cork, Ireland) , A. Lucey (Cork, Ireland) , S. Paul (Cork, Ireland) , Y. Al-Mukhaizeem (Cork, Ireland) , S. O'Connor (Cork, Ireland) , R.Y. Teo (Cork, Ireland) , P. Redmond (Cork, Ireland)
Background:
Primary hyperparathyroidism affects approximately 0.8% of the population across Ireland and the UK. It is a common cause of hypercalcemia, with surgery being the mainstay of treatment. In the majority of cases of primary hyperparathyroidism, there is single gland disease. There is a variety of techniques used to localize the pathological gland both preoperatively and intraoperatively. Institutions and surgeons utilize different intraoperative adjuncts in different protocols with varying results. The purpose of this article is to critically evaluate the combined use of all three intra-operative adjuncts used In parathyroid surgery to assess their utility, accuracy and their added value to the surgeon, as experienced at our centre
Methods:
We retrospectively analyzed a database of patients who underwent minimally invasive radioguided parathyroidectomy surgery in our unit to determine the sensitivity, positive predictive value and accuracy of intraoperative parathyroid hormon assay, the Norman 20% rule and frozen section analysis in detecting parathyroid adenomas.
Results:
151 patients underwent minimally invasive radioguided parathyroidectomy by one surgeon. Of these, 18 did not have intraoperative frozen section analysis and so were not included in the study. The drop of parathyroid hormone of >50% was positive in 128/133 cases, the Norman 20% rule was positive in 128/133 cases, Frozen section analysis was positive in 129/133 cases.
Conclusions:
Our study has proven that using three adjuncts (Including intraoperative PTH, frozen section and gamma probe) rather than one in isolation, improves the overall success of MIRP surgery in excising pathologic parathyroid glands.