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Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation

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Abstract

Purpose

Surgical removal of a mediastinal ectopic parathyroid is always challenging. We attempted to apply intraoperative radio-guided navigation for the minimally invasive focused removal of ectopic hyperparathyroid lesions in the mediastinum, and evaluated its significance.

Methods

Five cases with ectopic mediastinal hyperfunctioning parathyroid were treated by intraoperative radio-guided navigation surgery. MIBI (methoxyisobutylisonitrile)-SPECT (single-photon emission computed tomography) was used to plan the surgical approach. 99mTc-MIBI (11.1 MBq/kg) was administered 2 h before surgery, and a handheld gamma probe was used intraoperatively to detect radioactivity in the lesion.

Results

Two lesions found on the aortic arch were excised by left thoracoscopic resection. Two other lesions on the tracheal bifurcation were approached by right thoracotomy. We could remove two hidden adenomas by en bloc resection with the adjacent lymph nodes under radio-guidance. Another lesion, located at the ligamentum arteriosum, was excised with sternal division. Accumulations of radioactivity were identified in all lesions removed, with decreased radioactivity in the surgical field.

Conclusions

Intraoperative radio-guided navigation is a useful tool for the focused removal of an ectopic mediastinal parathyroid by providing instant feedback to help guide the surgeon, while also providing precise localization of lesions.

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Acknowledgments

We would like to thank Takashi Yamanaga for his remarkable technical support for generating the comprehensive SPECT and SPECT/CT images. This report was supported in part by a Grant-in Aid for Scientific Research (Kakenhi) #22591439.

Conflict of interest

The authors declare no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Naoyoshi Onoda, Tetsuro Ishikawa, Tsutomu Takashima & Kosei Hirakawa

  2. Department of Thoracic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Noritoshi Nishiyama

  3. Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Joji Kawabe

Authors
  1. Naoyoshi Onoda
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  2. Tetsuro Ishikawa
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  3. Noritoshi Nishiyama
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  4. Joji Kawabe
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  5. Tsutomu Takashima
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  6. Kosei Hirakawa
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Correspondence to Naoyoshi Onoda.

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Onoda, N., Ishikawa, T., Nishiyama, N. et al. Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation. Surg Today 44, 533–539 (2014). https://doi.org/10.1007/s00595-013-0547-z

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