Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism

Özet

Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority ofpHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improveintraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application,intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especiallypromising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence,indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imagingwith 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, andRaman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPTpatients with the aid of preoperative imaging and intraoperative auxiliary methods . The aim of the present study was to evaluatethe routinely used new promising intraoperative adjunct methods in pHPT.