Reoperative parathyroid surgery is a challenging problem for surgeons. The dense scar tissue and the small size of target lesions necessitate exact surgical localization. Many different techniques selleck bio have been employed to achieve such precision, including preoperative ultrasound, CT, MRI, and sestamibi scanning. Intraoperative selective venous sampling and serum parathyroid hormone (PTH) monitoring have also been utilized. Sestamibi and ultrasound are commonly used methods, with sensitivities ranging from 53�C98% and 56�C87%, respectively [1�C5]. When sestamibi and ultrasound are used, sensitivity increases to 67�C98% [1, 4, 5]. While the traditional approach has been bilateral neck exploration with identification of all parathyroid tissue [6], the recent literature has described numerous benefits to focused parathyroidectomy for patients with primary hyperparathyroidism.

These included less postoperative pain with decreased need for analgesia, a lower incidence of postoperative hypocalcemia, and better cosmesis [7, 8]. Shorter operative times and lower cost with equivalent results [9] make focused parathyroidectomy extremely attractive. The paper describes a novel, reproducible, and highly successful method of preoperative localization suitable for focused parathyroidectomy. 2. Methods After obtaining approval from the Institutional Review Board of Tulane University, a retrospective review of the charts of 10 nonconsecutive patients over a period of two years, presenting for reoperative treatment of persistent hyperparathyroidism was undertaken. 3.

Case Series Of the 10 patients, four were females and six males, with an average age of 50 years old (range: 25�C73 years old). All patients had a history of prior neck exploration for primary hyperparathyroidism, with persistent or recurrent hyperparathyroidism after the initial procedure (4 patients with recurrent and 6 with persistent hyperparathyroidism). After obtaining informed consent from 10 patients, sonography of the neck was performed to identify the parathyroid adenoma. These were compared with other imaging studies, including CT scan, when available. The skin was prepped in the standard fashion and local anesthesia administered. A Homer mammography needle wire device was introduced under ultrasound or CT guidance and the needle tip was guided to the appropriate position within the suspect parathyroid gland (Figure 1).

A 22-gauge Chiba needle was passed in a tandem fashion and GSK-3 aspiration of the lesion was performed. The specimens obtained were sent for cytology and/or PTH analysis (Table 1). Subsequently, 0.5mL methylene blue was instilled through the Homer needle and a hook wire passed through the Homer needle. Placement of the wire tip within the lesion was confirmed by ultrasound. At this point both the Homer needle and wire were left in place and secured, much like in mammographic lesion localization. The patients were then taken directly to the operating room.