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Scientific Publications Regarding Radioguided
Minimally Invasive Parathyroidectomy
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 Physicians
demand that new techniques/drugs/devices undergo scientific testing to prove their value.
This keeps "junk" science from becoming common place and assures that patients
are taken care of in the best possible manner. Once this testing has been completed, it is
subjected to reviews at national meetings and then reviewed by experts in the field. When
this is completed, the new procedure/drug/discovery is published in a reputable
"peer-reviewed" medical journal.
This page was updated February 24, 2003
 The first publication regarding the safety and
efficacy of Minimally Invasive Radioguided Parathyroidectomy
was published in the journal Surgery, 1997; 122:998-1004. This paper describes Dr. Norman's first 15 patients and emphasizes the safety of the
radioactivity for the surgeon and operating room personnel who will be exposed to hundreds
of radioactive patients (not an issue for an individual patient since it is such a low
radioactive dose and it is gone in 5-6 hours). All patients were cured with an operation
that lasted 44 minutes (nearly an hour faster than the old method). The cumulative
radioactive exposure to the operating room personnel was almost undetectable (reviewed by
the NRC) and therefore not deemed to be an issue (the authors no longer monitor
radioactivity!). This study was conducted under close scrutiny by hospital and university
medical boards at the University of South Florida (USF) to assure
the procedure was safe AND effective. Prior to publication, it was presented at the Annual
Meeting of the American Association of Endocrine Surgeons in Baltimore MD (April 1997).
Another of article on this subject examined the
ability of the sestamibi scan to predict which patients need only one side of their neck
operated on (those with just one bad parathyroid gland). This was not the first article to
show the success rate of operating, but the results confirmed those from other
institutions and showed that a smaller operation could be done through a smaller incision
under local anesthesia (i.e. Novocaine) instead of general anesthesia (put to sleep). This
also demonstrated a potential for fewer complications if a smaller operation is
undertaken. This was published by the USF group in the journal American Surgeon
1997; 44:235-230. Prior to publication this data was presented at the Annual meeting of
the Southeastern Surgical Association (February 1997).
Another recent paper was more of a technical "how
to" article was published by Dr. Norman in Cancer Control 1997; 4:500-504.
This was an invited article which was published with several additional articles by
experts in other areas of radio-guided surgery. This was a "how to"
article aimed at describing the technique to doctors.
An article looking at the cost savings of this type of
minimal surgery and the ability of nearly 90% of all patients with primary
hyperparathyroidism to undergo it was published by Dr. Norman's group in the Journal of
the American College of Surgeons in February, 1998; 398-405. Prior to publication,
this data was presented at the Annual Meeting of the American College of Surgeons
(November, 1997).
A
second article regarding the dramatic reduction in cost as well as
complication rates was published by Dr. Norman and collegues in the
journal American Surgeon, 1999; 65:796-799.
A
sixth article was published in January, 1999 by Dr.
Norman and the USF group in the journal Surgery which examines the utility of
radioguided techniques in 24 patients in whom a previous standard neck operation failed to
find the bad parathyroid gland. This study demonstrated that making the hyperactive gland
radioactive resulted in the locating of the gland 100% of the time in these
"re-exploration" cases, with about 90% still able to have the operation under
local anesthesia. Even in these more complex "re-do" operations, 22 of 24
patients went home within a few hours with the other 2 spending a single night in the
hospital. MIRP has since become the "standard of care" for
re-operations.
Two more "how to" book
chapters were published (Spring, 1999) by Dr. Norman aimed at describing the
subtle technicalities in performing this operation. One was in a book entitled
"Radioguided Surgical Techniques". The other was an invited
chapter in the Surgical Oncology Clinics of North America, a
very prestigious medical journal. (Surg Ocol Clin N Am,
1999;8:4082-4089)
The USF group
reported on 345 consecutive
minimal parathyroid operations (MIRPs) which were performed under local anesthesia with 98.9%
of the patients going home immediately afterward. Everyone is at least 10 months post-op
so long term hormone levels have been assessed...still 100 percent cure. This was
presented by Drs. Norman and Murphy at the May, 1999 meeting of the American Association
of Endocrine Surgeons and was published in the journal Surgery.
The real importance of this paper is that it demonstrates statistically how removing a
radioactive gland proves to the surgeon during the operation that the operation is
complete (proves the overactive gland has been removed) so he/she does not have to
continue to dissect through other parts of the patient's neck.
Dr.
Norman was wrote an invited editorial for the Journal of Nuclear
Medicine in December of 1999 regarding the technique of
radioguided parathyroid surgery and how surgeons need to work with
their nuclear medicine doctors closely if patients are to have a
great outcome. (Journal of Nuclear Medicine, 1999;39:15N-24N)
In
July 2001, Dr. Norman was issued a patent for his pioneering work
and the development of minimally invasive radioguided parathyroid
surgery (MIRP). U.S. Patent 6,263,232
A
very important review article on minimal parathyroid surgery
was written by Dr. Norman and published in one of the world's most
premier journals, Annals of Surgery. This article
discusses the choices that surgeons make in deciding what operation
to perform for patients with parathyroid disease, and how these
decisions affect patient outcomes. (Annals of Surgery,
2000;231:31-37).
What
do endocrinologists say about Minimal Parathyroid Surgery???
In March 2003, Dr. Norman and collegues will be presenting a paper
at a major endocrine meeting. Read the findings of this
very important paper here.
November
2002
In
October 2002, Dr. Norman was an invited key-note speaker at the
annual meeting of the American College of Surgeons. The topic
of this talk was long-term cure rates of MIRP (minimally invasive
radioguided parathyroid surgery). The manuscript for this
presentation will be published in 2003 in the Journal of the American
College of Surgeons.
Articles on MIRP
Minimally Invasive Radioguided Parathyroid Surgery
published by authors other than Dr Norman.
Effect of
minimally invasive radioguided parathyroidectomy on efficacy,
length of stay, and costs in the management of primary
hyperparathyroidism. Vanderbilt University Medical
Center, and the Nashville VA Medical Center, Nashville,
Tennessee. Annals
of Surgery, 2000 May;231(5):732-42.
“The
MIRP technique resulted in excellent cure rates for primary
hyperparathyroidism while simultaneously decreasing operative
time and hospital stays. These resulted in significant cost
reductions without compromising patient safety. The technique
is significantly changing the management of primary
hyperparathyroidism”
Radioguided
surgical advancements for head and neck oncology. Department
of Otolaryngology-Head and Neck Surgery, St. Louis University
School of Medicine.
Southern
Medical Journal, 2000 Apr;93(4):360-3 "The MIRP
parathyroid operation has the highest cure rate of all
parathyroid operations and is the procedure of choice"
Minimally
invasive radioguided parathyroidectomy. Department of
Surgery, University of Louisville School of Medicine, KY.
Journal of
the American College of Surgeons, 2000 Jul;191(1):24-31.
"MIRP
mini-parathyroid surgery is a safe and effective procedure,
resulting in the correction of hypercalcemia in all patients.
The cost of MIRP minimal surgery is significantly less. There
are many benefits for the patient and this has become the
parathyroid operation of choice.:
An initial
experience with radioguided parathyroid surgery.
Department of Surgery, Northwestern University Medical School,
Chicago, Illinois. American
Journal of Surgery, 2000 Dec;180(6):475-7.
"Those people who can have a MIRP mini parathyroid
operation will definitely benefit. It is the procedure of
choice."
A changing
experience with primary hyperparathyroidism at Group Health
Cooperative, Seattle.
American Journal of Surgery. 2001 May;181(5):445-8.
“The
combination of the sestamibi scan on the day of surgery and
the use of the gamma probe intraoperatively is a major advance
in the treatment of primary hyperparathyroidism”
Minimally
invasive, radioguided surgery (MIRP) for primary
hyperparathyroidism. Academic
Department of Surgery, National University of Ireland, Cork.
Annals of
Surgical Oncology. 2001 Dec;8(10):856-60. "The
MIRP parathyroid operation offers dramatic benefits to surgeon
and patient alike. Smaller operations are common with higher
cure rates and lower complication rates".
Radioguided
parathyroidectomy for re-exploration of primary
hyperparathyroidism.
Division
of Endocrine Surgery, Department of Surgery II, Nippon Medical
School, Tokyo, Japan. Medical
Science Monitor. 2002 Mar;8(3):CS21-5. "The
MIRP radioguided parathyroid operation is the procedure of
choice for patients who have had a previously failed standard
parathyroid operation or other forms of neck surgery".
Radioguided
parathyroidectomy (MIRP) combined with intraoperative
parathyroid testing: the surgical approach of choice for
patients with mediastinal parathyroid adenomas.
Department of Surgery, University of Wisconsin Medical School.
Journal of Bone and Mineral Research 2002 Aug;17(8):1368-71.
”Radioguided parathyroid surgery is the preferred method
for all mediastinal (chest) parathyroid tumors”
Radioguided
surgery in primary hyperparathyroidism. Department
of Nuclear Medicine, Ankara University Medical Faculty, Turkey.
Annals of Nuclear Medicine 2002 Jul;16(5):359-62.
“Using
the radioactive probe to find the parathyroid tumor limits the
surgical exploration and also the operation time and reduces
surgical complications.”
Determinant
role of Tc-99m Sestamibi in the localization of a
retrotracheal parathyroid adenoma successfully treated by
radioguided surgery.
Second Nuclear Medicine Service, Regional Hospital of Padua,
via Giustiniani 2, 35100 Padua, Italy. Clinical Nuclear Medicine
2002 Oct;27(10):711-5. "MIRP
radioguided parathyroid surgery is clearly the best way to
perform re-operations for parathyroid tumors in patients who
have had a previous neck operation."
Sestamibi
radio-guided
surgery in primary hyperparathyroidism: a prospective study of
128 patients.
Nuclear Medicine Service II, Radiotherapy Department, Azienda
Ospedaliera of Padua, Italy. Tumor,
2002 May-Jun;88(3):S63-5.
"The MIRP parathyroid operation is highly
effective. It has the highest cure rate and is also very good
for patients who had a previous (failed) parathyroid operation."
Prognosis of
parathyroid function after minimally invasive radioguided
parathyroidectomy (MIRP) for primary hyperparathyroidism.
Department of
Internal Medicine, Tokai University School of Medicine,
Bohseidai Isehara, Kanagawa, 259-1193, Japan. Biomedical
Pharmacotherapy 2002;56 Suppl 1:41s-47s. "The MIRP
parathyroid operation was associated with the highest cure
rate of all parathyroid operations and is the procedure of
choice for patients with all forms of parathyroid
disease."
This is a
partial listing. |
To learn more about the Minimally Invasive
Parathyroid Surgery Program at the Norman Endocrine Surgery
Clinic, Click
Here.
Return to Minimal Parathyroidectomy.
Illustrated guide to how the MIRP operation is
performed.
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