99m-technetium sestamibi localized solitary parathyroid adenoma as an indication for limited unilateral surgical exploration

BACKGROUND: Because of its successful localization of solitary adenomas, 99 m-Technetium sestamibi (MIBI) may challenge the standard operation for prim ary hyperparathyroidism. METHODS: Thirty-five consecutive patients underwent preoperative MIBI local ization to optimize a surgical approach. Single-site localization in 21 pat ients directed a limited unilateral neck exploration (UNE) with adenomectom y and ipsilateral gland biopsy. Fourteen patients who did not localize unde rwent bilateral neck exploration (BNE). Conversion to a bilateral operation was required in 1 UNE patient because no adenoma was found on that side. RESULTS: There were no significant differences in preoperative and postoper ative serological markers between the two groups. However, the total operat ive time for UNE (49 +/- 21 minutes) was significantly less than for BNE (1 03 +/- 45 minutes; P <0.001). CONCLUSIONS: Preoperative MIBI scan-directed limited unilateral neck operat ion may be used reliably for primary hyperparathyroidism due to a single ad enoma, and thereby reduce operative time, extent of surgical dissection, an d risk. Am J Surg. 1998;176:409-412. (C) 1998 by Excerpta Medica, Inc.