Operation duration and outcomes in parathyroidectomy: a comparative analysis of Tc-99m-MAA radioguided occult lesion localization, intravenous Tc-99m sestamibi gamma-probe guidance, and standard approaches.

PURPOSE: The surgical management of primary hyperparathyroidism (PHPT) has shifted toward minimally invasive, targeted approaches. In this retrospective study the clinical outcomes, safety, and operative durations of three distinct surgical techniques were compared: radioguided occult lesion localization (ROLL), intravenous Tc-99 m sestamibi gamma-probe guidance (IV MIBI), and standard minimally invasive parathyroidectomy. METHODS: This study is a single-center retrospective analysis of 178 patients who underwent surgery for parathyroid adenomas. Patients were categorized into three surgical cohorts: ROLL (n = 100), IV MIBI (n = 42), and standard minimally invasive parathyroidectomy (n = 36). Primary endpoints included operative duration, preoperative and 24-hour postoperative serum parathyroid hormone (PTH) and calcium levels, complication rates, and long-term surgical cure rates. A multivariate linear regression model was utilized to adjust for potential baseline confounding variables. RESULTS: The median operative duration was significantly shorter in the ROLL group (47 min) compared to both the IV MIBI group (87.5 min, p < 0.001) and the standard group (84 min, p < 0.001). Patients in the standard cohort presented with significantly higher preoperative PTH levels and larger adenoma diameters. Upon adjusting for confounders, the surgical method and preoperative PTH levels also remained independent predictors of operative duration (p < 0.05). There were no statistically significant differences among the groups regarding rates of early postoperative hypoparathyroidism or hypocalcemia. During long-term follow-up, very high cure rates were observed in all groups: a 100% cure rate was achieved in the ROLL group, whereas persistent hyperparathyroidism was observed in two patients in the IV MIBI group and one patient in the standard group. CONCLUSION: The ROLL technique is an effective targeted surgical approach for PHPT. By minimizing background tissue uptake and providing precise intralesional navigation, ROLL was associated with shorter operative duration with similar surgical cure rates when compared to systemic IV gamma-probe guidance and standard minimally invasive parathyroidectomy. However, prospective trials with larger cohorts are needed to confirm these clinical advantages.