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2010 Annual Meeting Abstracts

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Identification of the Second Gland during Minimally-Invasive Parathyroidectomy is Critical for Surgical Cure: A Prospective Review of 119 Patients with Concordant Localization.
*Nancy L Cho, *Eric G. Sheu, *Daniel T. Ruan, Atul A. Gawande, Francis D. Moore, Jr.
Brigham & Women's Hospital, Boston, MA

Objective: Validate the effectiveness of a protocol for primary hyperparathyroidism (PHPT) in which intra-operative parathyroid hormone (IOPTH) was not routinely used during minimally-invasive parathyroidectomy (MIP) for patients with concordant localization by sestamibi (MIBI) and ultrasound (US).
Design: Propspective cohort study.
Setting: Academic hospital (Brigham and Women's Hospital) from October 2005 to September 2009.
Patients: One hundred nineteen patients with PHPT and concordant localization by MIBI and US.
Interventions: Minimally-invasive parathyroidectomy.
Main Outcome Measures: Incidence of surgical cure following MIP without utilization of IOPTH for patients with concordant localization.
Results: We identified a total of 328 patients with PHPT who underwent parathyroid exploration at our institution from October 2005 to September 2009. In 136 patients (41%), MIBI and US imaging identified the same site of disease (imaging was concordant), and 119 patients were planned for MIP. Our surgery protocol for MIP without IOPTH was successful in 115 patients (97%), with 13 converted to bilateral exploration based on our criteria for intra-operative suspicion of multiglandular disease. Eight of these 13 explorations (62%) revealed multiglandular disease that was missed on imaging, of which 6 were apparent from examination of the ipsilateral second parathyroid. Four (3%) patients had persistent post-operative hypercalcemia necessitating re-operation, of which 4 (100%) had a near adjacent but unseen second adenoma. There was no significant difference in surgical cure rate following MIP without IOPTH for this prospective study compared with our previously published retrospective study (97% v. 99%, respectively; p=0.09).
Conclusions: Focused parathyroid exploration without IOPTH can be successfully perform in patients with concordant localization by MIBI and US; however, identification of the second ipsilateral gland is critical to ruling out undetected multiglandular disease.

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