Minimal-access parathyroid surgery using intraoperative parathyroid hormone assay

Objectives: Review the most current preoperative localization imaging techniques in patients with primary hyperparathyroidism and demonstrate their applicability to targeted tumor removal with intraoperative parathyroid hormone (PTH) monitoring. Study Design: Retrospective review of 40 consecutive patients undergoing parathyroid surgery with intraoperative PTH assay as the principal determinant of correction of the hyperparathyroid state, Details of the technology, cost analysis, and comparison with other management methods are discussed. Methods: The standard intact PTH chemiluminescent assay (Nichols Diagnostics) and modifications to allow accelerated intraoperative results are discussed in detail. The time intervals between completion of parathyroid excision and postremoval assay and subsequent laboratory investigation present a practical therapeutic algorithm, Results: Forty consecutive patients with hyperparathyroidism were treated surgically with intraoperative PTH as the determinant of satisfactory resolution of the disease state. In most instances, the surgical field was reduced to the targeted pathology identified by preoperative localization, and all patients became eucalcemic when this method was employed. Approximately half of eligible patients were treated under local anesthesia. Conclusions: Intraoperative PTH assay has added a new dimension to primary and revision parathyroid surgery. It is cost-effective and accurate and may reduce the morbidity of surgical intervention in revision procedures.