Is Intraoperative Parathyroid Hormone Assay Mandatory for the Success of Targeted Parathyroidectomy? Alejandra Gil-Cárdenas, MD, Rosa Gamino, SW, Alfredo Reza, MD, Juan Pablo Pantoja, MD, Miguel F Herrera, MD, PhD, FACS BACKGROUND: Minimally invasive parathyroidectomy has become the first surgical option for patients with primary hyperparathyroidism (HPT) in many places. Preoperative localization studies are man- datory, and the use of a quick parathyroid hormone (PTH) assay is highly recommended. The aim of this study was to analyze our initial series of targeted parathyroidectomies. STUDY DESIGN: In a 2-year period, 50 patients underwent unilateral neck exploration for HPT under local anesthesia and light sedation. After biochemical diagnosis, a technetium 99m sestamibi scan was performed on all patients, and cervical ultrasonography was obtained in some patients. Frozen section analysis was used to confirm parathyroid tissue in all patients. There was no biochemical intraoperative evaluation of PTH. Demographics, surgical details, results, and complications were analyzed. RESULTS: There were 35 women and 15 men, with a mean age of 56 years (range 23 to 85 years). Mean preoperative calcium was 11.4 mg/dL (range 10.0 to 14.8 mg/dL), and PTH was 342 pg/mL (range 105 to 2,231 pg/mL). Mean surgical time was 52 minutes (range 30 to 100 minutes), and mean hospital stay was 2 days (range 1 to 7 days). Mean parathyroid weight was 1,000 mg (range 117 to 17,000 mg). Sestamibi scan correctly localized the abnormal gland in 47 patients (94%). There was one postoperative complication (bleeding); two patients required contralat- eral exploration, and persistent hypercalcemia developed in one that required surgical reinter- vention. After a mean followup of 12 months (range 3 to 25 months), all patients were normocalcemic. CONCLUSIONS: Targeted parathyroidectomy is safe and effective. Despite the fact that quick intraoperative PTH assay was not used, the cure rate was 98%. ( J Am Coll Surg 2007;204:286–290. © 2007 by the American College of Surgeons) Primary hyperparathyroidism (HPT) is a common dis- ease that is successfully treated by operation. The under- lying pathology is a solitary adenoma in 85% to 90% of patients. 1 In 1975, Roth and colleagues 2 proposed unilateral neck exploration as a less invasive surgical alternative than the classic standard bilateral cervical exploration for treatment of the disease; this technique was subse- quently developed by Tibblin 3 and associates in Malmo, Sweden. The improvement of localizing imaging studies and the development of intraoperative parathyroid hor- mone (IOPTH) measurement made unilateral neck ex- ploration widely accepted by many endocrine surgeons around the world. Several variations of minimally inva- sive parathyroidectomy have evolved, including video- scopic, videoassisted, radioguided, and focused or tar- geted parathyroidectomy. In 2003, we planned to evaluate targeted parathyroid- ectomy in 50 patients with uniglandular disease diag- nosed by localizing studies. The aim of this study was to analyze our experience in this initial series of 50 patients. METHODS From January 2003 to June 2005, 74 patients were re- ferred to our service for surgical treatment of primary Competing Interests Declared: None. Received September 1, 2006; Revised October 17, 2006; Accepted October 30, 2006. From the Department of Surgery (Gil-Cárdenas, Gamino, Pantoja, Herrera) and the Department of Internal Medicine (Reza), Instituto Nacional de Cien- cias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Correspondence address: Miguel F Herrera, MD, Vasco de Quiroga 15, Tlalpan 14000, Mexico City, Mexico. 286 © 2007 by the American College of Surgeons ISSN 1072-7515/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2006.10.034