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Intra-operative Tools in Parathyroidectomy

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Parathyroid Gland Disorders

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Abstract

Surgery is the definitive treatment of primary hyperparathyroidism. Variations in the number and location of parathyroid glands (PTGs) reach up to approximately 25% for super-numerary and 43% for ectopic glands. The advantageous minimally invasive parathyroidectomy, which allows exposure of the diseased gland only, has currently replaced the time-honored bilateral neck exploration, which allowed the surgeon to visually inspect all PTGs. Intra-operative identification of PTGs is not easy since they may morphologically mimic fat, lymph nodes, or thyroid nodules; hence, surgeon expertise is invaluable. Both combined ultrasound and Sestamibi/single photon emission computed tomography (MIBI/SPECT), the two most commonly used modalities, have a pre-operative localization accuracy rate of nearly 91% for single-gland disease, but a significantly lower rate for multiple gland disease, smaller pathologies, and coexistent nodular thyroid disease. Many tools have thus been proposed to aid intra-operative identification of PTGs to facilitate optimal parathyroid surgery. This chapter addresses these intra-operative tools, which include methylene blue, frozen-section, gamma probe, intra-operative 3D-mapping using F-SPECT, intra-operative parathyroid hormone, intra-operative ultrasound, and operative fluorescence.

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  1. Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Mahmoud F. Sakr

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Sakr, M.F. (2022). Intra-operative Tools in Parathyroidectomy. In: Parathyroid Gland Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-07418-9_17

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