Potential role of a new hand-held miniature gamma camera in performing minimally invasive parathyroidectomy.

PURPOSE: Sestamibi scans have increased the use of minimally invasive parathyroidectomy (MIP) to treat primary hyperparathyroidism (PHPT) when caused by a parathyroid single adenoma. The greatest concern for surgeons remains the proper identification of pathological glands in a limited surgical field. We have studied the usefulness of a new hand-held miniature gamma camera (MGC) when used intraoperatively to locate parathyroid adenomas. To our knowledge this is the first report published on this subject in the scientific literature.

METHODS

Five patients with PHPT secondary to a single adenoma, positively diagnosed by preoperative sestamibi scans, underwent a MIP. A gamma probe for radioguided surgery and the new hand-held MGC were used consecutively to locate the pathological glands. This new MGC has a module composed of a high-resolution interchangeable collimator and a CsI(Na) scintillating crystal. It has dimensions of around 15 cmx8 cmx9 cm and weighs 1 kg. The intraoperative assay of PTH (ioPTH) was used to confirm the complete resection of pathological tissue.

RESULTS

All cases were operated on successfully by a MIP. The ioPTH confirmed the excision of all pathological tissues. The MGC proved its usefulness in all patients, even in a difficult case in which the first attempt with the gamma probe failed. In all cases it offered real-time accurate intraoperative images.

CONCLUSION

The hand-held MGC is a useful instrument in MIP for PHPT. It may be used to complement the standard tools used to date, or may even replace them, at least in selected cases of single adenomas.