Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Med Princ Pract 2009;18:373–377 DOI: 10.1159/000226291 Minimally Invasive Radionuclide-Guided Parathyroidectomy Using 99m Tc-Sestamibi in Patients with Primary Hyperparathyroidism: A Single-Institution Experience Sharjeel Usmani a Haider Ali Khan a Shihab al Mohannadi a Amir Javed a Naheel al Nafisi a Fawaz abu Huda a M. Tuli a Henney G. Amanguno c Majda A. Abdulla b K. Al Khalidi b Departments of a Nuclear Medicine, b Surgery and c Pathology, Hussain Makki Al Jumma Center for Specialized Surgery (HMJCSS), Kuwait single standard pinhole view of the neck. A skin marker was placed on the basis of maximum count intensity during gamma probe localization. Patients were then sent for radio- guided minimally invasive parathyroidectomy. Results: The preoperative localization of the affected gland was success- ful in all cases using a gamma probe and 99m Tc -sestamibi scintigraphy. The pathological parathyroid tissue was local- ized and successfully removed with the gamma probe. The histopathological diagnosis was parathyroid adenoma in 11 cases and hyperplasia in the remaining one. All patients re- mained disease and symptom free at 12-month follow-up. Conclusions: Our initial experience with intraoperative use of a gamma probe to carry out minimally invasive parathy- roidectomy was a useful, easy and safe procedure for treat- ing patients with primary hyperparathyroidism. Copyright © 2009 S. Karger AG, Basel Introduction Primary hyperparathyroidism, a disorder character- ized by excessive secretion of parathyroid hormone by one or more enlarged parathyroid glands, is caused main- Key Words Radio-guided parathyroidectomy  99m Tc-sestamibi  Parathyroid adenoma Abstract Objective: To evaluate the efficacy and usefulness of 99m Tc- sestamibi scintigraphy and gamma probe localization of parathyroid glands in patients with primary hyperparathy- roidism and establish radio-guided minimally invasive para- thyroidectomy at Hussain Makki Al Jumma Center for Spe- cialized Surgery, Kuwait. Subjects and Methods: Twelve patients with primary hyperparathyroidism (mean age: 48 8 14 years; median age: 46 years; age range: 29–68 years) were evaluated. The diagnosis of hyperparathyroidism was established by elevated serum calcium and parathyroid hor- mone levels. All patients had a well-defined parathyroid le- sion on previous standard 99m Tc-sestamibi scintigraphy with or without ultrasound study. All had a normal thyroid gland, no history of familial hyperparathyroidism or multiple endo- crine neoplasia nor any history of previous neck irradiation. On the day of surgery, patients were injected with 740 MBq (20 mCi) of 99m Tc -sestamibi followed by a half-hour-delayed Received: September 8, 2008 Revised: December 4, 2008 Sharjeel Usmani Department of Nuclear Medicine Hussain Makki Al Jumma Center for Specialized Surgery PO Box 1488, 83001 Khaitan (Kuwait) Tel. +965 761 3437, Fax +965 483 1733, E-Mail dr_shajji@yahoo.com © 2009 S. Karger AG, Basel 1011–7571/09/0185–0373$26.00/0 Accessible online at: www.karger.com/mpp