Radioguided surgery in primary hyperparathyroidism: a review of the different techniques available

Abstract Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional Choline, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT/CT and PET/CT with [18F]-Colina and morphological ones, such as ultrasound have played a crucial role in this paradigm’s shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.