Minimally invasive radioguided parathyroidectomy in the reoperative neck

Surgery. 1998 Dec;124(6):1088-92; discussion 1092-3. doi: 10.1067/msy.1998.92007.


Background: Operations for hyperparathyroidism (HPT) in a previously operated neck present a significant challenge and carry much higher morbidity rates than first-time operations. Our extensive experience with minimally invasive radioguided parathyroidectomy (MIRP) for first-time surgery for HPT has shown this method to be a directed approach to the offending adenoma, suggesting that the technique could be used to minimize reoperative neck surgery as well.

Methods: Over an 11-month period 24 consecutive patients with primary HPT who had undergone at least one previous neck operation were referred for re-exploration. All patients underwent preoperative sestamibi scanning; 21 localized sufficiently to undergo MIRP.

Results: All patients were cured after reoperation. Eighteen patients underwent MIRP under local anesthesia as outpatients; 3 MIRPs were done under general anesthesia. Average total operative time was 44 minutes, average incision length was 3.0 cm +/- 0.2 cm. Nineteen of the procedures were completed without any frozen sections. There were no complications.

Conclusion: MIRP is extremely effective in patients with HPT who have undergone previous neck exploration for parathyroid or thyroid disease. The technique allows for such a directed dissection that smaller incisions and local anesthesia in an outpatient setting are routine.

Publication types

  • Clinical Trial

MeSH terms

  • Adenoma / diagnostic imaging
  • Adenoma / surgery
  • Adult
  • Aged
  • Humans
  • Hyperparathyroidism / diagnostic imaging*
  • Hyperparathyroidism / surgery*
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Parathyroid Neoplasms / diagnostic imaging
  • Parathyroid Neoplasms / surgery
  • Parathyroidectomy / methods*
  • Radionuclide Imaging
  • Reoperation