Role of radio-guided surgery in recurrent secondary hyperparathyroidism

Background: The aim of this paper is to state the role of radio-guided surg ery (RGS) in case of recurrent secondary hyperparathyroidism. Methods: Two cases of recurrent secondary hyperparathyroidism were treated using RGS. Af ter a preoperative assessment, which included ultrasonography (US), MRI and Tc-99m-radiolabelled sestamibi scan, a radio-guided neck re-exploration wa s planned. On the day of surgery the patients underwent a radionuclide inje ction. After 90 min, surgery began. Results: Dissection was guided by placi ng the probe in the wound to localize any increased concentration of radioa ctivity. In the first case the probe identified the gland located deeply in the right tracheo-esophageal groove; in the other case the probe detected a site of increased uptake in the upper mediastinum. Both lesions were diss ected and excised; a frozen section confirmed they were parathyroid glands with diffuse hyperplasia. The operative time was less than 60 min in both c ases. The patients were discharged on the first postoperative day. A de cre ase in serum calcium and PTH was observed subsequently. A minimum follow-up of 6 months did not show any recurrence. Conclusion: RGS can help in detec ting the parathyroid tissue in selected cases of renal hyperparathyroidism and makes operation much easier and more predictable. Copyright (C) 2001 S. Karger AG, Basel.