Abstract
The authors thank Dr. Smith for his comments on our article “Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism.”
In our series, termination of the procedure was based upon rapid parathyroid hormone (PTH), although preoperative and postoperative radiation counts were measured and correlated. Although cost containment is important, these considerations have limited meaning if the patient's operation is unsuccessful. A number of authors have suggested that ex vivo confirmation of hyperfunctioning glands (20% rule) should indeed be confirmed using intraoperative rapid PTH. 1 , 2 Some have gone as far as suggesting that the gamma probe was the least essential component for successful operative management, 3 and therefore we felt that it was important to confirm successful excision by more than one method.
Many agree that intraoperative neural monitoring is an important adjunct to thyroid and parathyroid surgery. 4 This has been highlighted specifically in minimally invasive techniques. 5 We believe that patient safety is our primary goal, and use of intraoperative neural monitoring would seem to provide few negative results. Thus, this technology was added when it became available to the authors.
Last, authorship credit is based on criteria established by the International Committee of Medical Journal Editors, and, unfortunately, just being one of the surgeons in a series does not meet criteria for authorship. 6