Will directed parathyroidectomy utilizing the gamma probe or intraoperative parathyroid hormone assay replace bilateral cervical exploration as the preferred operation for primary hyperparathyroidism

摘要: The trend toward limited exploration for primary hyperparathyroidism (1 degrees HPT) has stemmed from advances in sestamibi scanning, gamma probe technology, and intraoperative parathyroid hormone monitoring (iPTH). Prior to widespread application, directed parathyroidectomy must be shown meet the high standards of conventional cervical exploration. In this prospective, nonrandomized trial, results utilizing probe, iPTH, or neither technique were evaluated. Altogether, 150 patients underwent (n = 50), iPTH 50). Each group was evaluated operating time, length hospitalization, cure rate, morbidity, mortality, cost. A telephone survey conducted with 25 each 75) address patient satisfaction. localized abnormal gland 66% confirmed intraoperatively 84%. group, a more than 50% decrease baseline occurred 98%. mean times 76, 84, 90 minutes, respectively (p 0.16); hospitalization 1 day. biochemical rates 98%, 100%, 96%, 0.17). Total costs $4476, $3918, $3905, respectively. total 96% all three groups "very satisfied" their surgical procedure. Directed assay does not significantly alter satisfaction when compared our practice. is expensive consistently reliable tool localizing pathology. PTH reliably predicts intraoperatively.