Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy (MIP) for Primary Hyperparathyroidism With Concordant Localisation.

Abstract

There is increasing use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP). While ioPTH has improved cure rate, there is little evidence to suggest effectiveness in primary hyperparathyroidism (PHP) with concordant preoperative localisation. This study aims to determine if ioPTH improves cure rates in such cases. A search of PubMed, Embase, and Cochrane databases identified studies that compared MIP with and without ioPTH, in patients with concordant preoperative imaging of ultrasonography and technetium-99m sestamibi (MIBI) scans. Inclusion criteria were comparative studies between years 2000 and 2023. Analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Primary outcome was the overall cure rate. Secondary outcomes analyzed include operative duration, and conversion to neck exploration. Six studies involving 884 patients were eligible for inclusion. The overall cure rate was 97.3%, higher in those that had ioPTH than without, but this was not statistically significant (98.3% vs 96.0%, P = .18). Operative duration was reported in 2 studies, showing significantly longer duration in the ioPTH group. Overall conversion rate to bilateral neck exploration was 6.64% in the ioPTH group, with a success rate of 4.80%. Use of ioPTH in MIP with concordant localization did not result in statistically significant higher cure rates. Operative time is potentially longer with use of ioPTH. It is difficult to justify the routine use of ioPTH for such cases based on cure rates alone; considerations should also be given to center-specific case volume, surgical experience, and overall cost outcomes.