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Scientific Publications Regarding Radioguided Minimally Invasive Parathyroidectomy

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,

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.

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.

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.