“Sneaker Power” and Laboratory Medicine

Dr. Karen Devon (left) and UHN’s Laboratory Medicine Program team. (Photo: UHN)

There aren’t many tests where the result is taken into the lab on “sneaker” power, but with Intraoperative parathyroid (PTH) testing at Women’s College Hospital – that is exactly how it happens.

Due to the fact that the patient is on the operating table and the result is needed immediately, the patient’s sample is physically run across the street from the operating room at Women’s College Hospital and into the core laboratory at Toronto General Hospital.

The laboratories at the University Health Network and Women’s College Hospital have been working together on various initiatives for some time. Intraoperative PTH testing is just another example of how our laboratories are able to work together with our clinicians, often with ‘outside the paradigm’ thinking, on how to get the job done for the patient.

An intraoperative PTH test is used when a patient is undergoing surgery for hyperparathyroidism. With hyperparathyroidism, a patient’s parathyroid glands in their neck are not functioning properly and are causing negative effects such as high calcium, osteoporosis, among other symptoms.

‘Surgery the only cure’

“Surgery is the only cure for hyperparathyroidism,” said Dr. Karen Devon, endocrine surgeon at Women’s College Hospital and UHN.

“In order to ensure that enough of the patient’s parathyroid glands have been removed, I take a baseline PTH before any glands are removed and then again approximately five minutes later after removal, and usually a third time to ensure that no further removal is necessary. When I’m operating on a patient, I need to know their PTH levels quickly so that I can make all the necessary decisions on my patient’s care,” she explained.

If additional intraoperative PTH tests are required, those tests are also run over to Toronto General and the same procedure is followed. All of the results are later entered into the patient’s medical record.

“We have several stat tests where we run the test immediately and call the result back into the OR,” said Tom Clancy, Director, Laboratory Medicine Program. “But, the intraoperative PTH project with Women’s College is one of the few tests I can think where it is literally run right out of the OR and into the laboratory because our result is that important for the patient.”

One of four in Ontario

There are currently only three other hospitals in the province, including UHN, that perform intraoperative PTH testing. Dr. Devon worked with the laboratory team from the beginning of the planning in order to make Women’s College Hospital the fourth.

“I believe that intraoperative PTH testing is a valuable test during surgery for hyperparathyroidism,” said Dr. Devon.

“Working with the laboratory team from the onset was crucial to the success of the initiative. We all needed to be working together, especially since this project was so unique, and we collaborated in a way that ensured we had the right test, could get the sample into the lab and relay the result back to the OR, so that we could make an immediate decision for the patient based on that result,” she continued. “It was an excellent collaboration and the project has been a success.”