Radioguided tumorectomy in the management of parathyroid adenomas.

HYPOTHESIS A clearly localizing sestamibi scan predicts a successful minimally invasive radioguided parathyroidectomy that can be performed with a shorter operative time, low morbidity, and decreased duration of hospital stay. DESIGN Review of prospectively gathered data and patient medical records. SETTING Hospitalized care. PATIENTS AND METHODS Parathyroidectomy was performed on 55 patients with a secure biochemical diagnosis of hyperparathyroidism and a sestamibi scan performed at the University of Connecticut Health Center. Of the 40 patients with a clearly positive sestamibi scan result, 31 underwent radioguided parathyroidectomy. The results of radioguided parathyroidectomy are compared with those of the standard bilateral exploration performed in the remaining 24 patients. MAIN OUTCOME MEASURES Ionized calcium concentration, postoperative complications, and operative time. RESULTS All patients were cured of hyperparathyroidism, and no patients experienced recurrent laryngeal nerve damage. Parathyroid adenomas were found at the predicted site in all 40 patients with a clearly localizing sestamibi scan. Of the 31 patients who underwent radioguided parathyroidectomy, a single parathyroid adenoma was identified in 30 patients, and a double adenoma was found in 1 patient. Conversion to a standard procedure was necessary in 1 patient with a large adenoma. The average operating room time was 128 minutes for the radioguided procedure and 224 minutes for the standard exploration. The average incision length for radioguided parathyroidectomy was 3.3 +/- 0.7 cm. CONCLUSIONS A clearly localizing sestamibi scan predicts that 97% of patients can undergo a successful and safe minimally invasive radioguided parathyroidectomy that requires less operative time than the standard exploration.