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Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels

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Abstract

Purpose

Adenoma is the main parathyroid disorder leading to primary hyperparathyroidism (PHP). Minimally invasive parathyroidectomy (MIP) is recognized as a valid procedure for adenoma-related PHP. It requires precise preoperative localization combining Tc-99m-MIBI (methoxy-isobutyl-isonitrile) scintigraphy and single-photon emission computed tomography (SPECT) with x-ray computed tomography (CT) and intraoperative confirmation of successful excision by change in intact parathormone (iPTH) levels. The study aim was to assess the surgery success in relation to these two parameters.

Methods

All patients operated on for PHP from 2005 to mid-2014 at our institution were retrospectively reviewed. MIP was performed in case of precise preoperative adenoma localization on scintigraphy, absence of past cervical surgery, and absence of concomitant thyroid resection necessity. In these patients, iPTH levels were monitored intraoperatively. Confirmation criteria for iPTH values were a return to normal level or a decrease >50 % of basal iPTH level.

Results

There were 197 PHP operations during the study period: 118 MIP and 79 bilateral neck explorations (BNEs). The MIP success rate was 95 % (112/118) with a preoperative MIBI scan ± CT accurate in 94 % (111/118) of the patients and with correct iPTH in 90 % (106/118) of the cases. Among the 12 iPTH levels that did not meet the confirmation criteria, 10 returned to normal range by postoperative day 2. Treatment failure appeared in three patients (one BNE, two MIPs).

Conclusions

Tc-99m-MIBI dual-phase scintigraphy with SPECT/CT is the key examination for functional and morphological parathyroid adenoma localization. If preoperative scintigraphy is obvious and intraoperative assessment is clear, one could possibly safely omit iPTH, as it may lead to unnecessary BNE in primary PHP.

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Authors’ contributions

GRJ: study conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and acceptance of the final version.

ND: study conception and design, analysis and interpretation of data, critical revision of the manuscript, and acceptance of the final version.

LP: analysis and interpretation of data, critical revision of the manuscript, and acceptance of the final version.

AB: analysis and interpretation of data, critical revision of the manuscript, and acceptance of the final version.

MM: study conception and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript, and acceptance of the final version.

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Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Gaëtan-Romain Joliat, Nicolas Demartines & Maurice Matter

  2. Department of Endocrinology, University Hospital CHUV, Lausanne, Switzerland

    Luc Portmann

  3. Department of Nuclear Medicine, University Hospital CHUV, Lausanne, Switzerland

    Ariane Boubaker

Authors
  1. Gaëtan-Romain Joliat
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  2. Nicolas Demartines
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  4. Ariane Boubaker
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  5. Maurice Matter
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Corresponding author

Correspondence to Maurice Matter.

Ethics declarations

- This study received no particular funding.

- This retrospective study based on chart review was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

- Informed consent was obtained from all individual participants included in the study.

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None.

Conflicts of interest

Gaëtan-Romain Joliat, Nicolas Demartines, Luc Portmann, Ariane Boubaker, and Maurice Matter have no conflicts of interest to disclose.

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Joliat, GR., Demartines, N., Portmann, L. et al. Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels. Langenbecks Arch Surg 400, 937–944 (2015). https://doi.org/10.1007/s00423-015-1358-z

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  • DOI: https://doi.org/10.1007/s00423-015-1358-z

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