We investigated a simple and reliable method for the preparation of 99Tcm-dimercaptosuccinic acid (99Tcm(V)-DMSA) without the addition of oxygen. The effect of pH, amount of reducing agent, and oxygen addition in the synthesis of 99Tcm(V)-DMSA were evaluated. At pH 9, we obtained a radiochemical yield of 95% +/- 1.2% within 10 min and a high stability until 7 h, with 92% +/- 1.5% radiochemical purity. However, at a pH lower than 9, the radiochemical yield was below 90% within 10 min, and a longer reaction time was needed to obtain a radiochemical yield above 90%. The addition of oxygen did not have an additional effect on the radiochemical yield or its stability at pH 9, whereas it increased the radiochemical yield of 99Tcm-(V)-DMSA at pH 7. It was noted that the smaller the amount of reducing agent used, the higher was the radiochemical yield obtained at pH 7. However, at pH 9, the radiochemical yield was not dependent on the amount of reducing agent. In conclusion, the synthesis of 99Tcm(V)-DMSA was more dependent on the pH of the reaction mixture than on the amount of reducing agent or the addition of oxygen. The adjustment of pH 9 was the easiest and most effective method for the synthesis of 99Tcm(V)-DMSA using a commercial kit for 99Tcm(III)-DMSA.