Gamma probe guided minimally invasive parathyroidectomy in the treatment of primary hyperparathyroidism
Abstract
Giriş: Bu çalışmada, preoperatif paratiroid subtraction sintigrafisi ile lokalizasyon yeri tespit edilmiş primer hiperparatiroidisi olan hastalarda gama prob rehberliğinde minimal invazif paratiroidektominin etkinliğini araştırıldı.
Yöntem: Primer hiperparatiroidisi olan ve preoperatif Methoxyisobütylisonitrit tutulumu olan 30 hastaya gama prob rehberliğinde minimal invazif yöntemle lateral yaklaşımla ortalama 2,5 cm’lik insizyonla sternokleidomastoid kasın mediali, strep adale lateral sınırından loja girilerek kitleyi eksize edildi.
Bulgular: Ortalama ameliyat süresi 50 dakika saptandı. Çıkarılan kitlenin paratiroid adenomu olduğunu gama prob ölçümleri ile teyid edildi. Ayrıca 30 hastada da (%100) kitle çıkarılmadan hemen önce ve kitle çıkartıldıktan 10 dakika sonra ölçülen serum parathormon düzeyi düşüşü %50’den fazla saptandı. Böylelikle de çıkarılan kitlenin paratiroid olduğunu teyid edildi. Sadece 3 hastada 2 hastada sestamibinin yanlış lokalizasyonu, 1 hastada da büyük adenomdan dolayı) genel anesteziye geçilerek insizyonu genişletmek zorunda kalındı.
Sonuç: Preoperatif olarak sestamibi ile lokalizasyonu tespit edilebilen primer hiperparatiroidili hastalarda, gama prob yardımlı minimal invazif paratiroidektominin etkili ve güvenli bir yöntem olduğu sonucuna varıldı.
References
- Uludag M. Normocalcemic hyperparathyroidism: A new clinical type of primary hyperparathyroidism. Ş.E.E.A.H. Tıp Bülteni 2014;48(4):264-73.
- Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99:3561-9.
- Mossinelli C, Saibene AM, De Pasquale L, Maccari A. Challenging neck mass: non-functional giant parathyroid adenoma. BMJ Case Rep. 2016 Aug 17;2016: bcr2016215973. doi: 10.1136/bcr-2016-215973. PMID: 27535730; PMCID: PMC5015183.
- Aygün N, Uludağ M. Surgical Treatment of Primary Hyperparathyroidism: Which Therapy to Whom? Med Bull Sisli Etfal Hosp 2019;53(3):201–214.
- Bayraktar M: Asemptomatik hiperparatiroidizmde cerrahi gerekli mi ?: Yeni Tıp Dergisi 17 (1): 6-7, 2000.
- Purnell DC, Smith LH, Scholz DA, Elveback LR, Primary hyperparathyro- idism: a prospective clinical study. Am J Med. 50 (5): 670-8, 1971.
- M. Jonathan Worsey, MBBS, FRCS (Eng), Sally E. Carty, MD, Charles G. Watson, MD, FACS. Succes of unilateral neck explortion for sporadic primary hyperparathyroidism. Presented at the Fourteenth Annual Meeting of the American Association of Endocrine Surgeons, Williamsburg, Va., April 25- 27,1993.
- William B. Inabnet, Yvonne Fulla, Bruno Richard, Philippe Bonnichon, Philippe Icard, Yves Chapuis. Unilateral neck exploration under local anesthesia: The approach of choice for asymptomatic primary hyperparathyroidism. Presented at the 20th Annuel Meeting of the American Association of Endocrine Surgeons. New Haven, Conn, May 2-4, 1999.
- Robert J. Lucas, Robert J. Welsh, John L. Glover. Unilateral Neck Exploration for Primary Hyperparathyroidisim. Arch Surg- Vol 125, August 1990.
- D. Rubello, G. Mariani, M. R. Pelizzo on behalf of the Italian Group of Radioguided Surgery and ImmünoScintigraphy (GISCRIS). Minimal invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patiens. Nüklearmedizin 2007; 46:85-92.
- George L. Irvin, George T. Deriso. A New, Practical Intraoperative Parathyroid Hormone Assay. The American Journal of Surgery Volume 168 November 1994.
- Gaurav Agarwal, Bruce H. Barraclough, Tom S. Reeve, Leigh W. Delbridge. Minimally Invasive Parathyroidectomi Using the Focused Lateral Approach. II. Surgical Technique. Surg. 2002; 72: 147-151.
- Richard E. Goldstein, Lewis Blevins, Dominique Delbeke, William H. Martin. Effect of Minimally Invasive Radioguided Parathyroidectomy on Efficacy, Length of Stay, and Costs in the Management of Primary Hyperparathyroidisim. Presented at the 111 th Annual Meeting of the Southern Association December. 5-8. 1999.
- Shindo ML, Rosenthal JM, Lee T. Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches. Otolaryngol Head Neck Surg. 2008 Mar;138(3);381-7.
- Barczynski M, Cichon S, Konturek A, Cichon W. Minimally invasive video assisted parathyroidectomy versus open minimally invasive parathyrodectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg. 2006 May; 30(5):721-31.
- Livingston CD, Victor B, Askew R, ağabeykhalid J, Meynig J, Lindsey M, Jones L. Surgeon- performed ultrasonography as an adjunct to minimally invasive radio-guided parathyroidectomy in 100 consecutive patiens with primary hyperparathyroidisim. Endocr Pract. 2008 Jan-Feb; 14(1):28-32.
- S. K. Thomas, E. M. Gurnell, Mc Farlane, I. Munday, P. R. Raggat, K. K. Balan, L. Berman, V. K. K. Chatterjee, G. C. Wishart. A pilot study of minimally invasive 60 parathyroid surgery, with intra-operative parathyroid hormon (PTH) measurement, as a day case procedure. Br. J. Vol. 90, Suppl. 1, June 2003.
- Shindo ML, Roshental JM. Minimal accsess parathyroidectomy using the focused lateral approach: Technique, indication, and results. Arch Otolaryngol Head Neck Surg. 2007 Dec; 133(12):1227-34.
- Domenico Rubello, Maria Rosa Pellizo, Giuseppe Boni, Riccardo Schiavo, Luca Vaggelli, Giuseppa Villa, Sergio Sandrucci, Andrea Piotto, Gianpiero Manca, Pierluigi Marini, Giuliano Mariani. Radioguided Surgery of Primary Hyperparathyroidisim Using the Low-Dose Tc99m Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and ımmunoscintigtaphy (GISCRIS). The Journal of Nuclear Medicine Vol. 46. No:2 February 2005.
Abstract
Giriş: Bu çalışmada, preoperatif paratiroid subtraction sintigrafisi ile lokalizasyon yeri tespit edilmiş primer hiperparatiroidisi olan hastalarda gama prob rehberliğinde minimal invazif paratiroidektominin etkinliğini araştırıldı.
Yöntem: Primer hiperparatiroidisi olan ve preoperatif Methoxyisobütylisonitrit tutulumu olan 30 hastaya gama prob rehberliğinde minimal invazif yöntemle lateral yaklaşımla ortalama 2,5 cm’lik insizyonla sternokleidomastoid kasın mediali, strep adale lateral sınırından loja girilerek kitleyi eksize edildi.
Bulgular: Ortalama ameliyat süresi 50 dakika saptandı. Çıkarılan kitlenin paratiroid adenomu olduğunu gama prob ölçümleri ile teyid edildi. Ayrıca 30 hastada da (%100) kitle çıkarılmadan hemen önce ve kitle çıkartıldıktan 10 dakika sonra ölçülen serum parathormon düzeyi düşüşü %50’den fazla saptandı. Böylelikle de çıkarılan kitlenin paratiroid olduğunu teyid edildi. Sadece 3 hastada 2 hastada sestamibinin yanlış lokalizasyonu, 1 hastada da büyük adenomdan dolayı) genel anesteziye geçilerek insizyonu genişletmek zorunda kalındı.
Sonuç: Preoperatif olarak sestamibi ile lokalizasyonu tespit edilebilen primer hiperparatiroidili hastalarda, gama prob yardımlı minimal invazif paratiroidektominin etkili ve güvenli bir yöntem olduğu sonucuna varıldı.
Keywords
References
- Uludag M. Normocalcemic hyperparathyroidism: A new clinical type of primary hyperparathyroidism. Ş.E.E.A.H. Tıp Bülteni 2014;48(4):264-73.
- Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99:3561-9.
- Mossinelli C, Saibene AM, De Pasquale L, Maccari A. Challenging neck mass: non-functional giant parathyroid adenoma. BMJ Case Rep. 2016 Aug 17;2016: bcr2016215973. doi: 10.1136/bcr-2016-215973. PMID: 27535730; PMCID: PMC5015183.
- Aygün N, Uludağ M. Surgical Treatment of Primary Hyperparathyroidism: Which Therapy to Whom? Med Bull Sisli Etfal Hosp 2019;53(3):201–214.
- Bayraktar M: Asemptomatik hiperparatiroidizmde cerrahi gerekli mi ?: Yeni Tıp Dergisi 17 (1): 6-7, 2000.
- Purnell DC, Smith LH, Scholz DA, Elveback LR, Primary hyperparathyro- idism: a prospective clinical study. Am J Med. 50 (5): 670-8, 1971.
- M. Jonathan Worsey, MBBS, FRCS (Eng), Sally E. Carty, MD, Charles G. Watson, MD, FACS. Succes of unilateral neck explortion for sporadic primary hyperparathyroidism. Presented at the Fourteenth Annual Meeting of the American Association of Endocrine Surgeons, Williamsburg, Va., April 25- 27,1993.
- William B. Inabnet, Yvonne Fulla, Bruno Richard, Philippe Bonnichon, Philippe Icard, Yves Chapuis. Unilateral neck exploration under local anesthesia: The approach of choice for asymptomatic primary hyperparathyroidism. Presented at the 20th Annuel Meeting of the American Association of Endocrine Surgeons. New Haven, Conn, May 2-4, 1999.
- Robert J. Lucas, Robert J. Welsh, John L. Glover. Unilateral Neck Exploration for Primary Hyperparathyroidisim. Arch Surg- Vol 125, August 1990.
- D. Rubello, G. Mariani, M. R. Pelizzo on behalf of the Italian Group of Radioguided Surgery and ImmünoScintigraphy (GISCRIS). Minimal invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patiens. Nüklearmedizin 2007; 46:85-92.
- George L. Irvin, George T. Deriso. A New, Practical Intraoperative Parathyroid Hormone Assay. The American Journal of Surgery Volume 168 November 1994.
- Gaurav Agarwal, Bruce H. Barraclough, Tom S. Reeve, Leigh W. Delbridge. Minimally Invasive Parathyroidectomi Using the Focused Lateral Approach. II. Surgical Technique. Surg. 2002; 72: 147-151.
- Richard E. Goldstein, Lewis Blevins, Dominique Delbeke, William H. Martin. Effect of Minimally Invasive Radioguided Parathyroidectomy on Efficacy, Length of Stay, and Costs in the Management of Primary Hyperparathyroidisim. Presented at the 111 th Annual Meeting of the Southern Association December. 5-8. 1999.
- Shindo ML, Rosenthal JM, Lee T. Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches. Otolaryngol Head Neck Surg. 2008 Mar;138(3);381-7.
- Barczynski M, Cichon S, Konturek A, Cichon W. Minimally invasive video assisted parathyroidectomy versus open minimally invasive parathyrodectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg. 2006 May; 30(5):721-31.
- Livingston CD, Victor B, Askew R, ağabeykhalid J, Meynig J, Lindsey M, Jones L. Surgeon- performed ultrasonography as an adjunct to minimally invasive radio-guided parathyroidectomy in 100 consecutive patiens with primary hyperparathyroidisim. Endocr Pract. 2008 Jan-Feb; 14(1):28-32.
- S. K. Thomas, E. M. Gurnell, Mc Farlane, I. Munday, P. R. Raggat, K. K. Balan, L. Berman, V. K. K. Chatterjee, G. C. Wishart. A pilot study of minimally invasive 60 parathyroid surgery, with intra-operative parathyroid hormon (PTH) measurement, as a day case procedure. Br. J. Vol. 90, Suppl. 1, June 2003.
- Shindo ML, Roshental JM. Minimal accsess parathyroidectomy using the focused lateral approach: Technique, indication, and results. Arch Otolaryngol Head Neck Surg. 2007 Dec; 133(12):1227-34.
- Domenico Rubello, Maria Rosa Pellizo, Giuseppe Boni, Riccardo Schiavo, Luca Vaggelli, Giuseppa Villa, Sergio Sandrucci, Andrea Piotto, Gianpiero Manca, Pierluigi Marini, Giuliano Mariani. Radioguided Surgery of Primary Hyperparathyroidisim Using the Low-Dose Tc99m Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and ımmunoscintigtaphy (GISCRIS). The Journal of Nuclear Medicine Vol. 46. No:2 February 2005.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Medical Education |
| Journal Section | Articles |
| Authors | |
| Publication Date | June 29, 2024 |
| Submission Date | June 6, 2024 |
| Acceptance Date | June 15, 2024 |
| Published in Issue | Year 2024 Volume: 10 Issue: 2 |
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