Minimally Invasive Radioguided Parathyroidectomy (MIRP)
At the New York Center for Advanced Parathyroid Surgery, we have the benefit of placing our operative suites next to our imaging facility enabling the ready use of the Minimally Invasive Radioguided Parathyroidectomy (MIRP) Surgery technique. This permits the convenience and use of the intraoperative gamma counter, if indicated, shortly after sestamibi injection while the parathyroid adenoma nuclear activity is still elevated.
The minimally invasive radioguided parathyroidectomy technique was popularized in the late 1990s and still plays a role for certain cases. MIRP plays a useful role in assisting the surgeon with localizing the parathyroid adenoma intraoperatively.
About 97% of parathyroid disease patients have only one bad parathyroid. So rather than use the traditional parathyroid operation technique requiring a large neck incision to locate and examine the four parathyroid glands, the MIRP surgical technique simply remove the one bad gland and leave the others alone.
The Steps Required For Minimally Invasive Parathyroid (MIRP) Surgery
The overproducing parathyroid gland is made radioactive so it can be differentiated from the other structures in the neck. By using the Sestamibi scan, only the parathyroid tumor becomes radioactive.
Now that the surgeon knows what general area to operate upon, the surgeon makes a small incision and only operates in a small area of the neck.
A miniature hand-held radiation probe is inserted into the incision to find the radioactive parathyroid. Then the surgeon dissects where there is greatest probe activity in the area of the overactive parathyroid tumor.
Once the tumor is removed, the surgeon measures the radioactivity in the parathyroid to make sure that all of the radioactive tumor has been removed. The surgeon will then determine whether more operating is necessary.
Finally, the neck is bandaged and the patient is ready to go home. Because the MIRP operation is performed quickly and with limited dissection, patients can usually leave the hospital the same day. Overall pain is minimal, and the bandage is left in place for about a week.
Advantages to Minimally Invasive Radioguided Parathyroidectomy
There are several differences between the standard parathyroid surgery techniques performed by general surgeons and the MIRP surgery performed by specialists.
- With MIRP, the surgeon has a better idea which of the four parathyroid glands is diseased prior to the operation.
- The surgeon only needs to operate on one very small area of the neck rather than exposing both sides of the thyroid and neck. The operation is typically performed through a 2.5cm (1 inch) incision rather than the usual 14 cm (6 to 10 inch) incision.
- MIRP is frequently performed without general anesthesia.
- The average operative time is less than half an hour vs 2 to 5 hours with traditional procedures.
- The cure rates for the MIRP procedure is as high or higher than with the more extensive and complicated traditional operation.
- Because the operation is smaller, there is less overall pain.
- Almost all patients can go home within a few hours of the operation rather than spending a few days in the hospital.
Plan for your Surgery
The New York Center for Advanced Parathyroid Surgery will help you every step of the way. Our office team will work with you to assemble your laboratory and imaging information before your arrival. To help ensure that your stay near our center is comfortable and enjoyable, we provide a variety of concierge services to assist in travel and lodging accommodations.
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