Skip to main content
Log in

Three-dimensional ultrasonography before minimally invasive focused parathyroidectomy: The importance of coronal images

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the usefulness of three-dimensional (3D) ultrasonography (US) as a noninvasive preoperative localization procedure before performing minimally invasive focused parathyroidectomy in patients with primary hyperparathyroidism (pHPT).

Methods

Seventy-six patients with a solitary adenoma detected by US underwent minimally invasive focused parathyroidectomy. The value of 3D US was assessed by dividing patients into a 2D group and a 3D group. Age, the preoperative serum intact parathyroid hormone (PTH) level, operative time, length of skin incision, and weight of the resected specimen were compared between the groups, and multivariate analysis of the operative time was performed.

Results

There were no significant differences between the 2D group and the 3D group in age, the preoperative intact PTH level, length of skin incision, or weight of the resected specimen, but the mean operative time was significantly longer in the 2D group (P < 0.01). Multivariate analysis revealed that 3D US and the weight of the resected specimen were correlated with the operative time (P < 0.05).

Conclusion

The coronal images obtained by 3D US assist in the precise localization of parathyroid masses in patients with pHPT undergoing minimally invasive focused parathyroidectomy for a solitary adenoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Inabnet WB, Fulla Y, Richard B, Bonnichon P, Icard P, Chapuis Y. Unilateral neck exploration under local anesthesia: the approach of choice for asymptomatic primary hyperparathyroidism. Surgery 1999;126:1004–1009.

    Article  PubMed  CAS  Google Scholar 

  2. Harber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with 99mtechnetium sestamibi scintigraphy. Clin Endocrinol 2002;57:241–249.

    Article  Google Scholar 

  3. Barczynski M, Cichon S, Konturek A, Cichon W. Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blind trial. World J Surg 2006;30:721–731.

    Article  PubMed  Google Scholar 

  4. Barczynski M, Golkowski F, Konturek A, Buziak-Bereza M, Cichon S, Hubalewska-Dydejczkt A, et al. Technetium-99msestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. Clin Endocrinol 2006;65:106–113.

    Article  Google Scholar 

  5. Rodgers SE, Hunter GJ, Hambuerg LM, Schellingerhout D, Doherty DB, Ayers GD, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 2006;6:932–941.

    Article  Google Scholar 

  6. Lo CY, Lang BH, Chan WF, Kung AWC, Lam KSL. A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. Am J Surg 2007;193:155–159.

    Article  PubMed  CAS  Google Scholar 

  7. De Feo ML, Colagrade S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, et al. Parathyroid glands: combination of 99mTc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393–402.

    PubMed  Google Scholar 

  8. Shaema J, Mazzaglia P, Milas M, Berber E, Schuster DM, Halkar R, et al. Radionuclide imaging for hyperparathyroidism (HPT): Which is the best technetium-99m sestamibi modality? Surgery 2006;140:856–865.

    Article  Google Scholar 

  9. Chanpuis Y, Fulla Y, Bonnichon P, Tarla PE, Abboud B, Pitre J, et al. Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1–84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg 1996;20:835–840.

    Article  Google Scholar 

  10. Mazzeo S, Caramella D, Lencioni R, Molea N, De Liperi A, Marcocci C, et al. Comparison among sonography, double-tracer subtraction scintigraphy and double-phase scintigraphy in the detection of parathyroid lesions, Am J Roentgenol 1996;166:1465–1470.

    CAS  Google Scholar 

  11. Hindie E, Melliere D, Simon D, Perlemuter L, Galle P. Primary hyperparathyroidism: is technetium 99m-sestamibi/iodine-123 subtraction scanning the best procedure to locate enlarged parathyroid glands before surgery? J Clin Endocrinol Metab 1995;80:302–307.

    Article  PubMed  CAS  Google Scholar 

  12. Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenoma. Surgery 2000;128:29–35.

    Article  PubMed  CAS  Google Scholar 

  13. Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, et al. Values of ultrasonography, sestamibi scintigraphy, a intraoperative measurement of 1–84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg 1996;20:835–840.

    Article  PubMed  CAS  Google Scholar 

  14. Arici C, Cheah Wk, Ituarte PHG, Morita E, Lynch TC, Siperstein AE, et al. Can localization studies be used to direct focused parathyroid operation? Surgery 2001;129:720–729.

    Article  PubMed  CAS  Google Scholar 

  15. Biertho LD, Kim C, Wu HS, Unger P, Inabnet W. Relationship between sestamibi uptake, parathyroid hormone assay, and nuclear morphology in primary hyperparathyroidism. J Am Coll Surg 2004;199:229–233.

    Article  PubMed  Google Scholar 

  16. Chiu B, Sturgeon C, Angelos P. What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy. Surgery 2006;140:418–422.

    Article  PubMed  Google Scholar 

  17. Masatsugu T, Yamashita H, Noguchi S, Nishi R, Koga Y, Watanabe S, et al. Thyroid evaluation in patients with primary hyperparathyroidism. Endocrinol J 2005;52:177–182.

    Google Scholar 

  18. Wolf RJ, Cronan JJ, Monchik JM. Color Doppler sonography: an adjunctive technique in assessment of parathyroid adenomas. J Ultrasound Med 1994;13:303–308.

    PubMed  CAS  Google Scholar 

  19. Varsamidis K, Vaesamidou E, Mavropoulos G. Color Doppler sonography in the detection of parathyroid adenomas. Head Neck 1999;21:648–651.

    Article  PubMed  CAS  Google Scholar 

  20. Scheiner JD, Dupuy DE, Monchik JM, Noto RB, Cornan JJ. Pre-operative localization of parathyroid adenomas: a comparison of power and color Doppler ultrasonogrpahy with nuclear medicine scintigraphy. Clin Radiol 2001;56:984–988.

    Article  PubMed  CAS  Google Scholar 

  21. Abbound B, Sleilaty G, Ayoub S, Hachem K, Smayra T, Ghorra C, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively? World J Surg 2007;31:817–823.

    Article  Google Scholar 

  22. van Dalen A, Smit PC, Van Vroonhoven TJMV, Burger H, De Lange EE. Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 2001;220:631–639.

    Article  PubMed  Google Scholar 

  23. Beyer TD, Solorzano CC, Starr F, Nilubol N, Printz RA. Parathyroidectomy outcomes according to operative approach. Am J Surg 2007;193:368–373.

    Article  PubMed  Google Scholar 

  24. Smit PC, Rinkes IH, van Dalen, van Vroonhoven TJ. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: an alternative to conventional neck exploration? Ann Surg 2000;231:559–565.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miyabe, R. Three-dimensional ultrasonography before minimally invasive focused parathyroidectomy: The importance of coronal images. Surg Today 39, 98–103 (2009). https://doi.org/10.1007/s00595-008-3845-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-008-3845-0

Key words

Navigation