The history of the parathyroid surgery

Abstract

Rev. Col. Bras. Cir. 2016; 43(3): INTRODUCTION Hyperparathyroidism is a condition in whichthere is an abnormal increase in the levels of parathyroid hormone (PTH), responsible for regulating the level of blood calcium and phosphate. The most common cause of hyperparathyroidism, seen in about 80% of cases, is the primary gland dysfunction due to an adenoma. Multiple adenomas or hyperplasia of the parathyroid glands are diagnosed in the remaining patients. Rarely the cause of hyperparathyroidism is a result of a parathyroid carcinoma. It is a disease for which therapy may be surgical, which involves the removal of the affected gland. When surgery is indicated in patients without prior treatment, the cure rate approaches 95% 1 . In cases where the initial operation is not successful, new surgical explorations become necessary, greatly increasing the number of complications and decreasing success rates to about 80% 2 . Therefore, regardless of the hyperparathyroidism origin, the surgeon who will treat these patients must indisputably have skill, experience and technical knowledge to obtain satisfactory results. Currently, advances in the identification of the glands through preoperatively performed diagnostic tests greatly facilitated parathyroid glands surgery. Frozen section biopsies 3 , intraoperative measurement of PTH levels 4 and less invasive procedures 5 allow great improvement in patients' quality of life 6 .However, the identification of the parathyroid glands, the recognition of their important role and the understanding of diseases that affect them traveled a long journey to the present state of knowledge. Since inception, the history of the parathyroid glands is full of incidental findings, often the case in medical history.The aim of this study is to provide the reader with a historical review of the discoveries fundamental to the understanding of the parathyroid glands and to discuss the current role and future prospects of surgery for the treatment of hyperparathyroidism. ANATOMY OF THE PARATHYROIDSThe parathyroid glands originate from the third and fourth pharyngeal pouches and are usually located 214-222 A B S T R A C TThe authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism.Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment.

Hypocalcemia: What a Surgeon should know

“…27 Indeed, this was first evident when patients who underwent TT by Theodor Kocher, using his principles of bloodless surgery, had a lesser incidence of postoperative hypocalcemia as compared with those operated by Billroth. 28 However, a recent study found that patients operated by surgical trainees had complications that were comparable to patients operated on by consultant surgeons.…”

Edward D. Churchill (1895-1972): An Innovative Surgeon, His Work, and His Contribution to Parathyroid Surgery

“…At the same time, the first parathyroid tumors and adenomas were described, and the premier autotransplantations were rehearsed. 14 By 1920’s, knowledge on the parathyroid glands had entered a new era. The parathyroid hormone was isolated in 1924.…”

Parathyroidectomy in dialysis patients: Indications, methods, and consequences

“…Parathyroid surgeries were often prolonged, tedious, and unsuccessful operations in the past. However, the advances in technology and the adaptation of minimally invasive techniques now allows performing surgeries with very short hospital stay, less pain, lower cost, and minimal scars . In‐hospital mortality rates after PTX for SHPT steadily declined between 2002 and 2011 and were <1% in recent years …”