Abstract
Background
Detection of normal and pathologic parathyroid glands often is difficult because of their variability in number and location. The feasibility and efficacy of a fluorescence technique for identifying parathyroids have already been proved in an experimental setting. This is the first report of human fluorescence-guided parathyroidectomy.
Methods
A 72-year-old man with primary hyperparathyroidism underwent minimally invasive videoscopically assisted parathyroidectomy after photosensitiz- ation with aminolevulinic acid. Under special fluorescence illumination by the D-light, a unilateral directed neck exploration was performed.
Results
The enlarged adenoma and an atrophic parathyroid gland could be identified rapidly and removed because of their intense red fluorescence. Surrounding structures such as thyroid, muscles, and soft tissue remained nonfluorescent and could easily be distinguished from the parathyroid glands.
Conclusions
The aminolevulinic acid–induced fluorescence technique represents a convincing visual detection method for intraoperative identification of parathyroid glands. The technique serves as an additional tool requiring only moderate technical and clinical expenditure for help in guiding dissection down to a preoperatively localized adenoma. When used together with preoperative ultrasonography and sestamibi scan, the fluorescence technique may justify a unilateral, minimally invasive approach for selected patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bergenfelz A, Kanngiesser V, Zielke A, Nies C, Rothmund M (2005) Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 92: 190–197
Burkey SH, Snyder WH III, Nwariaku F, Watumull L, Mathews D (2003) Directed parathyroidectomy: feasibility and performance in 100 consecutive patients with primary hyperparathyroidism. Arch Surg 138: 604–608
Chen H, Mack E, Starling JR (2003) Radio-guided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 238: 332–338
Chou FF, Lee CH, Chen JB, Hsu KT, Sheen-Chen SM (2002) Intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidism. Arch Surg 137: 341–344
Gahlen J, Prosst RL, Herfarth Ch (2000) Blue light illumiantion for minimally invasive fluorescence detection of tumors: technology, clinical experience, and future perspectives. Min Invas Ther Allied Technol 9: 119–124
Gahlen J, Winkler S, Flechtenmacher C, Prosst RL, Herfarth Ch (2001) Intraoperative fluorescence visualization of the parathyroid gland in rats. Endocrinology 142: 5031–5034
Goldstein RE, Billheimer D, Martin WH, Richards K (2003) Sestamibi scanning and minimally invasive radio-guided parathyroidectomy without intraoperative parathyroid hormone measurement. Ann Surg 237: 722–730
Inabnet WB III, Kim CK, Haber RS, Lopchinsky RA (2002) Radioguidance is not necessary during parathyroidectomy. Arch Surg 137: 967–970
Katz SC, Wang GJ, Kramer EL, Roses DF (2003) Limitations of technetium 99m sestamibi scintigraphic localization for primary hyperparathyroidism associated with multiglandular disease. Am Surg 69: 170–175
Mandl F (1925) Therapeutischer Versuch bei Osteitis fibrosa generalisata mittels Exstirpation eines Epithelkörperchentumors. Wien Klin Wochenschr 50: 1343–1344
Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, Manca G, Casara D, Sotti G, Erba P, Volterrani D, Giuliano AE (2003) Preoperative localization and radio-guided parathyroid surgery. J Nucl Med 44: 1443–1458
Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT (1998) Endoscopic endocrine surgery in the neck: an initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 12: 202–205
Nichol PF, Mack E, Bianco J, Hayman A, Starling JR, Chen H (2003) Radio-guided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery 134: 713–717
Orloff LA (2001) Methylene blue and sestamibi: complementary tools for localizing parathyroids. Laryngoscope 111: 1901–1904
Pellitteri PK (2003) Directed parathyroid exploration: evolution and evaluation of this approach in a single-institution review of 346 patients. Laryngoscope 113: 1857–1869
Prosst RL, Schroeter L, Gahlen J (2004) Kinetics of intraoperative fluorescence diagnosis of parathyroid glands. Eur J Endocrin 150: 743–747
Prosst RL, Schroeter L, Gahlen J (2005) Enhanced ALA-induced fluorescence in hyperparathyroidism. J Photochem Photobiol B 79: 79–82
Rubello D, Piotto A, Casara D, Muzzio PC, Shapiro B, Pelizzo MR (2003) Role of gamma probes in performing minimally invasive parathyreoidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures. Eur J Endocrin 149: 7–15
Saaristo RA, Salmi JJ, Koobi T, Turjanmaa V, Sand JA, Nordback IH (2002) Intraoperative localization of parathyroid glands with gamma counter probe in primary hyperparathyroidism: a prospective study. J Am Coll Surg 195: 19–22
Smit PC, Thijssen JH, Borel Rinkes ICH, van Vroonhoven TJ (1999) Peroperative parathyroid hormone assay: assurance of successful surgical treatment of primary hyperparathyroidism. Nederlands Tijdschrift voor Geneeskunde 143: 742–746
Acknowledgments
The authors thank Nicole Decker for her invaluable help and effort spent in this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Prosst, R.L., Willeke, F., Schroeter, L. et al. Fluorescence-guided minimally invasive parathyroidectomy: a novel detection technique for parathyroid glands. Surg Endosc 20, 1488–1492 (2006). https://doi.org/10.1007/s00464-005-0471-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0471-4