Parathyroid scintigraphy in preoperative detection of parathyroid adenomas and use of gama probe in minimal invasive surgery

Abstract

Clinical or subclinical hyperparathyroidism is one of the most common endocrine disorders. Excessive secretion of parathyroid hormone is most frequently caused by an adenoma of a parathyroid gland or glands. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy has been made possible by the introduction of 99mTc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. Especially in ectopic localizations of parathyroid gland and its lesions preoperative localization have undeniable value. In minimally invasive technique the incision is small, dissection is minimal, postoperative pain is less, and hospital stay is shorter. Minimally invasive technique is easy, safe, with a low morbidity rate and has better cosmetic results lower overall cost than conventional bilateral neck exploration. In this technique greatly aided by intraoperative guidence with a gamma probe, based on in vivo radioactivity counting after administrating 99mTc-MIBI. In pres¬ent article, we reviewed actual literature on the preoperative localization of parathyroid adenomas and radioguided minimal invasive surgery.

Keywords

• Paratyhroid adenoma, minimal invasive, surgery, parathyroid scintigraphy, gamma probe

Parathyroid scintigraphy in preoperative detection of parathyroid adenomas and use of gama probe in minimal invasive surgery

Öz

Aşikar ya da subklinik hiperparatiroidi klinikte en sık karşılaşılan endokrin bozukluklardan biridir. Paratiroid hormonun bir ya da daha fazla paratiroid bezindeki adenomdan aşırı salgılanması en sık görülen hiperparatiroidi nedenidir. Geleneksel yöntemle yapılan paratiroid cerrahisinde iki taraflı boyun eksplorasyonu yaklaşımı kullanılmakta iken minimal invaziv paratiroidektomide 99mTc-sestamibi paratiroid sintigrafisi ile preoperatif olarak lezyonun yeri tespit edilmektedir. Özellikle ektopik paratiroid glandından kaynaklanan lezyonlarda adenomun yerinin tespit edilmesinin önemi büyüktür. Minimal invaziv teknikte ameliyat kesisi küçük olmakta, diseksiyon minimal ölçülerde kalmakta, ameliyat sonrası ağrı daha az olmakta ve hastane yatışları daha kısa sürmektedir. Bu teknik ile yapılan operasyonlar konvansiyonel iki taraflı boyun eksplorasyonuna göre daha kolay, güvenli, düşük morbiditeye neden olan, kozmetik olarak daha iyi sonuçlar veren ve genel maliyeti düşüren sonuçlara sahiptir. Bu teknik, intraoperatif olarak kullanılan ve IV yoldan enjekte edilen 99mTc-MIBI gama prob ile sayılmasını baz alan nükleer tıp metodu ile başarılı bir biçimde desteklenmektedir. Bu makalede Güncel literatüre ait paratiroid adenomlarının preoperatif lokalizasyonun tanınması ve minimal invaziv paratiroid cerrahisinde paratiroid sintigrafisi ve gama prob kullanımına ait bilgilerin gözden geçirilmesi amaçlanmıştır. Anahtar kelimeler: Paratiroid adenom, minimal invaziv, cerrahi, paratiroid sintigrafisi, gama prob

Anahtar Kelimeler

• Paratiroid adenom, minimal invaziv, cerrahi, paratiroid sintigrafisi, gama prob

Kaynakça

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