分子バイオマーカーと診断のジャーナル

Effectiveness of Intraoperative Parathyroid Monitoring (IoPTH) During Minimally - Invasive Parathyroidectomy: A Decade Experience in a Single Center

Abstract

Dobrinja C, Lanzaro A, Cubisino A, Stenner E, Ruscio M, Dore F, Bortul M and De Manzini Nicolò

Background: Aim of this study was to analyse our results of oriented parathyroidectomy (minimally-invasive parathyroidectomy (MIP) minimally-invasive video-assisted parathyroidectomy (MIVAP); and to confirm the usefulness of intra-operative parathyroid hormone (PTH) monitoring (ioPTH) when using minimally invasive techniques for treatment of sporadic primary hyperparathyroidism (pHTP). Material and methods: From June 2005 to May 2017, in the Division of General Surgery of University of Trieste, we operated 137 patients with pHPT. Minimally invasive video-assisted parathyroidectomy (MIVAP) by an anterior approach was proposed for 60 (43.8%) patients with sporadic pHPT and one unequivocally enlarged parathyroid gland on pre-operative ultrasound and 99mTc-SestaMIBI scintigraphy without previous neck surgery. Intraoperatively, a quick parathyroid assay was used during the last 107 (78.1%) surgical procedures. All patients underwent preoperative investigations of calcemia, phoshoremia and PTH levels and vocal cord function. Age, gender, operative times, pathologic findings, calcemia, PTH, length of hospital stay and complications were retrospectively analyzed. Results: MIVAP was successfully accomplished in 60 patients. Mean operative time was 87 minutes. Postoperative complications included 12/137 (8.75%) transient hypocalcemia. No laryngeal nerve palsies, no definitive hypocalcemias, no persistent pHPT and no recurrent pHPT were observed. Pre-operative 99mTc-SestaMIBI scintigraphy revealed the correct position of parathyroid adenoma in 91 cases (66.4%). Conclusion: Our decade experience in a single center demonstrated that minimally invasive parathyroidectomy for localized single-gland adenoma seems to have significant advantages, especially in terms of cosmetic results and post-operative pain, if performed by dedicated team, with an adequate activity volume. Moreover, the ioPTH determinations are very important during minimally invasive parathyroidectomy, as it allows avoiding bilateral neck exploration.