INTRAOPERATIVE PHOTODYNAMIC IMAGING OF THE PARATHYROID GLANDS USING 5-AMINOLEVULINIC ACI

The main treatment method of the manifest forms of primary and tertiary hyperparathyroidism is surgical. In doing so, the success of surgical intervention is determined by the removal of all pathologically altered parathyroid tissue. In spite that the only interoperative increasing of the parathyroid hormone may validate the radicalism of intervention, nowadays the fluorescence diagnostic, techniques, which provides the visualisation and differentiation of altered and unchanged parathyroid glands during the surgery, are being developed. The results of examination and treatment of patients with surgical diseases of the parathyroid glands who were operated using a minimally invasive endoscopically-assisted technique under conditions of intraoperative parathyroid monitoring with 5-aminolivulenic acid. Examination of patients was carried out in the framework of international protocols and clinical recommendations. All patients underwent preoperative topical diagnosis of pathologically altered parathyroid glands, including ultrasound examination of the neck and scintigraphy with 99mTc-technetrile. An intraoperative search for parathyroids accumulating 5-aminolevolenic acid was carried out using a polarized blue source in a darkened operating room. As a result of the study, it was found that the use of intraoperative parathyroid monitoring with 5-aminolevulinic made it possible to search and differential diagnosis of not changed parathyroid glands and parathyroid, thereby facilitating the radicalism of interventions, the prevention of postoperative hypoparathyroidism, relapse and persistence of the disease. Thus, photodynamic imaging of the parathyroid glands is a safe auxiliary methodology aimed at achieving a new level of evidence and safety of surgical interventions in primary and tertiary hyperparathyroidism.

parathyroid surgery, hyperparathyroidism, parathyroidectomy, intraoperative parathyreomonitoring, parathyreomonitoring, fluorescence diagnostics, 5-aminolevulinic acid