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Gonioprobe, an Innovative Gamma-probe to Guide Parathyroid Radioguided Surgery: First Clinical Experiences with Navigator and Lock-ontarget Functions

[ Vol. 14 , Issue. 2 ]

Author(s):

Marco Bononi, Frantellizzi Viviana*, Maria Silvia De Feo, Saadi Sollaku, Arianna Pani, Rita Falconi, Roberto Pani, Giuseppe Cavallaro, Stefania Brozzetti and Giuseppe De Vincentis   Pages 161 - 169 ( 9 )

Abstract:


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: 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: 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: 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.

Keywords:

Gamma-probe, parathyroid, radio-guided surgery, 99mTcSestamibi, primary hyperparathyroidism, innovative.

Affiliation:

Department of General and Plastic Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161 Rome, Department of Molecular Medicine, Sapienza, “Sapienza” University of Rome, Viale Regina Elena,324, 00161 Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, “Sapienza” University of Rome, Viale Regina Elena,324, 00161 Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, “Sapienza” University of Rome, Viale Regina Elena,324, 00161 Rome, Department of oncology and hemato- oncology, University of Milan “Statale”, Specialty School in Medical Physics, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Department of General and Plastic Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161 Rome, Department of General and Plastic Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161 Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza, “Sapienza” University of Rome, Viale Regina Elena,324, 00161 Rome



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