Authors: Ali Allami Faruque Riffat Furqan Alamgir Raghav Dwivedi Laurence Berman Brian Fish Piyush Jani
Publish Date: 2012/11/27
Volume: 270, Issue: 6, Pages: 1903-1908
Abstract
Objectives of this study were to assess the utility of intraoperative ultrasound to resolve discordant preoperative imaging prior to a lateral approach miniparathyroidectomy by studying prospective case series in a head and neck endocrine unit Patients with primary hyperparathyroidism due to a single adenoma with discordant preoperative ultrasound and sestamibi were enrolled They underwent a further intraoperative ultrasound by a head and neck radiologist with a view to proceed with a miniparathyroidectomy The main outcome measure was utility of intraoperative ultrasound compared to operative findings and preoperative imaging Secondary measures were complications of miniparathyroidectomy operative and ambulatory discharge time Twentytwo patients underwent surgery with intraoperative ultrasound in the surgical position The intraoperative ultrasound findings correlated with the operative findings in all cases 100 There were 16 inferior adenomas and 6 superior adenomas Six inferior adenomas were in a retrosternal position eight were obscured by benign thyroid lesions and a further two reported preoperatively as superior Three out of six superior adenomas were reported as inferior preoperatively as the inferior thyroid artery was inadequately visualised two were retrocarotid and one was retrooesophageal All patients were discharged within 23 h of surgery There were no unsuccessful focused explorations Histological analysis confirmed the adenomas No morbidity vocal cord palsy haematoma hungry bones was noted The results indicated that intraoperative ultrasound by a dedicated radiologist is a valuable tool in resolving discordance of preoperative imaging Appropriate patient positioning with neck extension and muscle relaxation allows placement of the probe in the obscure retrocarotid and retrooesophageal locations and unmasks apparent “mediastinal” parathyroids facilitating focused dissection
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