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SURGICAL PICTURE OF PARATHYROID ADENOMA (MIRP & MIVAP)
Parathyroid Adenoma in minimally invasive radioguided parathyroidectomy (MIRP)
This patient presented with hyperparathyroidism. A positive Technetium 99m-Sestamibi scan showed a right inferior parathyroid adenoma. Using the Neoprobe, the location of the adenoma was marked on the skin prior to the operation. To help visualize the adenoma, an intravenous infusion of methylene blue was administered. This dye is known to stain the parathyroids with a deep blue color. A small 4 cm-incision was made just above the right clavicle. The right sternocleidomastoid muscle was retracted. The sternohyoid muscles were separated in the midline and retracted. The dark blue adenoma immediately came into view, inferior to the right thyroid lobe and lateral to the trachea.
Parathyroid Adenoma
Magnified picture of the adenoma shown above. Note the blue color from the methylene blue infusion. This adenoma weighed 350 mg (Normal parathyroid glands weigh 30-40 mg).
Parathyroid identification by methylene blue infusion.
Aust N Z J Surg. 1978 Jun;48(3):314-7.
Bambach CP, Reeve TS.
A preoperative infusion of methylene blue was employed in 20 patients undergoing neck exploration for hyperparathyroidism. The dye was noted to stain adenomas and hyperplastic glands a deep purple-blue colour. Normal parathyroid tissue stained to a lesser extent or not at all. All unstained parathyroid tissue was normal histologically. Methylene blue infusion is a safe method of more rapidly identifying parathyroid tissue. Its preferential staining of abnormal parathyroid tissue can assist the surgeon in deciding the extent of his parathyroid excision.
Otolaryngology Houston
Bechara Y. Ghorayeb, MD
8830 Long Point, Suite 806
Houston, Texas 77055
For appointments, call 713 464 2614
For a couple of days after surgery, patients who have received methylene blue to localize the parathyroids, will continue to notice a bluish green discoloration of the urine. Although methylene blue has been successfully used for more than 30 years in parathyroid surgery, there are some extremely rare side effects that could happen from the administration of this dye. These include confusion, hallucinations and abnormal limb movements that may last a few days before slowly subsiding.
