Gonioprobe, an Innovative Gamma-probe to Guide Parathyroid Radioguided Surgery: First Clinical Experiences with Navigator and Lock-ontarget Functions.
Adult
Aged
Biopsy
Costs and Cost Analysis
Female
Gamma Cameras
Humans
Hyperparathyroidism, Primary
/ surgery
Male
Middle Aged
Operative Time
Parathyroid Neoplasms
/ surgery
Parathyroidectomy
/ methods
Postoperative Complications
Radionuclide Imaging
Radiopharmaceuticals
Recurrent Laryngeal Nerve Injuries
/ prevention & control
Surgery, Computer-Assisted
/ methods
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
99mTcSestamibi
Gamma-probe
innovative
parathyroid
primary hyperparathyroidism
radio-guided surgery
Journal
Current radiopharmaceuticals
ISSN: 1874-4729
Titre abrégé: Curr Radiopharm
Pays: United Arab Emirates
ID NLM: 101468718
Informations de publication
Date de publication:
2021
2021
Historique:
received:
17
02
2020
revised:
19
05
2020
accepted:
20
05
2020
pubmed:
23
7
2020
medline:
21
9
2021
entrez:
23
7
2020
Statut:
ppublish
Résumé
Radioguided surgery represents a validated technique for the detection and the excision of abnormal parathyroid glands responsible for primary hyperparathyroidism (PHPT). To date little attention has been paid as to how the characteristics of gamma-probes can influence surgical procedure and time, thus having an impact on postoperative morbidity, hospitalization and costs. We designed a new prototype of gamma-probe, the Gonioprobe, and tested its clinical utility in the operating room. Gonioprobe, thanks to its 5 scintillating independent crystals, performs the dual function of Navigator and Lock-on-target. These characteristics allow the immediate guidance of the surgeon's hand towards the source with very high precision, and with a much higher spatial resolution than commercial probes. Gonioprobe was used during intervention to detect abnormal parathyroid tissue, and to ensure no radioactivity in surgery bed after adenoma removal. We tested our gamma-probe on parathyroid adenomas particularly difficult to identify at a visual inspection due to anatomy modifications from previous neck surgery and/or characterized by uncommon localization. Moreover, parathyroid adenomas were hardly removable due to the proximity to the esophagus, neck vessels and/or recurrent laryngeal nerve (RLN). An intraoperative nerve monitoring system was used to protect the recurrent laryngeal nerve from injuries. Parathyroid hormone (PTH) assay and frozen biopsy confirmed the successful excision of the adenomas. The intraoperative use of the innovative Gonioprobe along with the nerve monitoring system allowed an accurate and safe removal of parathyroid adenomas and offered a significant advantage by reducing surgical time and postoperative complications, as well as hospitalization and costs.
Sections du résumé
BACKGROUND
BACKGROUND
Radioguided surgery represents a validated technique for the detection and the excision of abnormal parathyroid glands responsible for primary hyperparathyroidism (PHPT). To date little attention has been paid as to how the characteristics of gamma-probes can influence surgical procedure and time, thus having an impact on postoperative morbidity, hospitalization and costs.
METHODS
METHODS
We designed a new prototype of gamma-probe, the Gonioprobe, and tested its clinical utility in the operating room. Gonioprobe, thanks to its 5 scintillating independent crystals, performs the dual function of Navigator and Lock-on-target. These characteristics allow the immediate guidance of the surgeon's hand towards the source with very high precision, and with a much higher spatial resolution than commercial probes. Gonioprobe was used during intervention to detect abnormal parathyroid tissue, and to ensure no radioactivity in surgery bed after adenoma removal.
RESULTS
RESULTS
We tested our gamma-probe on parathyroid adenomas particularly difficult to identify at a visual inspection due to anatomy modifications from previous neck surgery and/or characterized by uncommon localization. Moreover, parathyroid adenomas were hardly removable due to the proximity to the esophagus, neck vessels and/or recurrent laryngeal nerve (RLN). An intraoperative nerve monitoring system was used to protect the recurrent laryngeal nerve from injuries. Parathyroid hormone (PTH) assay and frozen biopsy confirmed the successful excision of the adenomas.
CONCLUSION
CONCLUSIONS
The intraoperative use of the innovative Gonioprobe along with the nerve monitoring system allowed an accurate and safe removal of parathyroid adenomas and offered a significant advantage by reducing surgical time and postoperative complications, as well as hospitalization and costs.
Identifiants
pubmed: 32693772
pii: CRP-EPUB-108356
doi: 10.2174/1874471013666200721013903
doi:
Substances chimiques
Radiopharmaceuticals
0
Technetium Tc 99m Sestamibi
971Z4W1S09
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
161-169Informations de copyright
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