Our Summary

This research paper discusses two types of minimally invasive surgery to remove overactive parathyroid glands, a condition known as primary hyperparathyroidism. The first method uses a specific type of scan (MIBI scintigraphy) and neck ultrasound to accurately find the overactive glands before the operation. The second method, known as radioguided minimally invasive parathyroidectomy, is even more effective. This technique allows the surgeon to use a smaller incision and has fewer complications. It also allows the surgeon to immediately confirm that the overactive gland has been removed. This method is particularly useful for patients with glands that are not in the usual location or who have had previous neck surgery. The paper goes into detail about the indications, protocols, and differences between these two methods.

FAQs

  1. What is minimally invasive parathyroidectomy and when is it the preferred choice?
  2. What are the benefits of using a radioguided technique for minimally invasive parathyroidectomy?
  3. What are the differences between the two available radioguided parathyroid surgery procedures, MIBI and R.O.L.L.?

Doctor’s Tip

A doctor might advise a patient undergoing minimally invasive surgery to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities that could disrupt the healing process. It is important to communicate any unusual symptoms or concerns to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for minimally invasive surgery for primary hyperparathyroidism include those with precise preoperative localization of parathyroid adenoma by MIBI scintigraphy (SPECT/CT) and neck ultrasound, as well as those with ectopic lesions or a history of cervical surgery. Radioguided minimally invasive parathyroidectomy is especially effective in these cases, as it shortens surgical times, maintains minimal incision and has few complications. The two available radioguided parathyroid surgery procedures, MIBI and R.O.L.L., have their own indications, protocols, and differences that should be considered when determining the best approach for each patient.

Timeline

Before minimally invasive surgery:

  • Patient presents with symptoms of primary hyperparathyroidism, such as fatigue, weakness, bone pain, and frequent urination.
  • Patient undergoes diagnostic tests, including blood tests to measure calcium and parathyroid hormone levels, as well as imaging studies such as MIBI scintigraphy (SPECT/CT) and neck ultrasound to localize the parathyroid adenoma.
  • Surgeon evaluates the imaging results and determines the best approach for surgery.

After minimally invasive surgery:

  • Patient undergoes radioguided minimally invasive parathyroidectomy, which involves a small incision and the use of a gamma probe to locate and remove the parathyroid adenoma.
  • Surgical times are shortened, and complications are minimized.
  • Immediate verification of adenoma removal is performed, ensuring the success of the procedure.
  • Patients with ectopic lesions or a history of cervical surgery may benefit from this technique.
  • Patient recovery time is typically shorter than traditional open surgery, with a quicker return to normal activities.

What to Ask Your Doctor

  1. What are the benefits of minimally invasive parathyroidectomy compared to traditional open surgery?
  2. How is the parathyroid adenoma precisely located before surgery using MIBI scintigraphy and neck ultrasound?
  3. What is the difference between radioguided minimally invasive parathyroidectomy and traditional minimally invasive parathyroidectomy?
  4. How does radioguided minimally invasive parathyroidectomy shorten surgical times and reduce complications?
  5. Are there any specific indications or situations in which radioguided minimally invasive parathyroidectomy is especially beneficial?
  6. What is the protocol for undergoing radioguided minimally invasive parathyroidectomy?
  7. How soon after the surgery can the removal of the parathyroid adenoma be verified?
  8. Are there any potential risks or complications associated with radioguided minimally invasive parathyroidectomy that I should be aware of?
  9. How does having an ectopic lesion or previous cervical surgery history affect the effectiveness of radioguided minimally invasive parathyroidectomy?
  10. Are there any alternative treatment options for primary hyperparathyroidism that I should consider before undergoing minimally invasive parathyroidectomy?

Reference

Authors: Blanco Saiz I, Salvador Egea P, Anda Apiñániz E, Rudic Chipe N, Goñi Gironés E. Journal: Cir Esp (Engl Ed). 2023 Mar;101(3):152-159. doi: 10.1016/j.cireng.2022.09.001. Epub 2022 Sep 5. PMID: 36067944