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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Radioguided surgery in primary hyperparathyroidism: a review of the different te...
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Vol. 40. Issue 1.
Pages 57-66 (January - February 2021)
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Vol. 40. Issue 1.
Pages 57-66 (January - February 2021)
Continuing Education
Radioguided surgery in primary hyperparathyroidism: a review of the different techniques available
Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles
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E. Goñi Gironésa,
Corresponding author
elena.goni.girones@navarra.es

Corresponding author.
, S. Fuertes Caberob, I. Blanco Sáiza, I. Casáns-Tormoc, P. García-Talavera San Migueld, J. Martín Gile, C. Sampol Basf, P. Abreu Sánchezg, R. Díaz Expósitoh, S. Vidal-Sicarti
a Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Spain
b Servicio de Medicina Nuclear, H. Universitario Quironsalud Madrid, Madrid, Spain
c Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, Spain
d Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, Spain
e Servicio de Cirugía General, Hospital Quirónsalud San José, Madrid, Spain
f Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Mallorca, Spain
g Servicio de Medicina Nuclear, Hospital Universitario Doctor Peset, Valencia, Spain
h Servicio de Medicina Nuclear, Fundación Instituto Valenciano de Oncología, Valencia, Spain
i Servicio de Medicina Nuclear, Hospital Clinic Barcelona, Barcelona, Spain
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Table 1. Summary of the most relevant results of minimally invasive parathyroidectomy with [99mTc]Tc-MIBI.
Abstract

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional Choline, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT/CT and PET/CT with [18F]-Colina and morphological ones, such as ultrasound have played a crucial role in this paradigm’s shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

Keywords:
Surgical treatment primary hyperparathyroidism
Minimally invasive parathyroidectomy
ROLL
RSL
ICG
Resumen

La paratiroidectomía ha evolucionado a lo largo de los años desde la exploración bilateral del cuello hasta el abordaje de una sola glándula mediante una cirugía mínimamente invasiva. La localización prequirúrgica precisa de la glándula problema, mediante técnicas funcionales, como la gammagrafía doble fase con [99mTc]Tc-MIBI incluyendo SPECT/TC y PET/TC con [18F]-Colina y morfológicas, como la ecografía han tenido un papel crucial en este cambio de paradigma. También las técnicas de cirugía radioguiada han ido adaptándose y creciendo con nuevas aportaciones conocidas por su indicación en otros campos. De esta forma, en la actualidad disponemos de un amplio abanico de técnicas que han venido a sumarse a la paratiroidectomía mínimamente invasiva radioguiada con [99mTc]Tc-MIBI, que fue la primera y de la que se dispone una mayor experiencia. Entre ellas, en la presente actualización, comentaremos la paratiroidectomía mediante ROLL guiado por ecografía, también gracias a la localización mediante 125I semillas y, por último, técnicas hibridas que utilizan radiotrazador y fluorescencia.

Palabras clave:
Tratamiento quirúrgico hiperparatiroidismo primario
Paratiroidectomía mínimamente invasiva
ROLL
RSL
ICG

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