A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy

Shan, Cheng-Xiang; Qiu, Nian-Cun; Zha, Siluo; Liu, Miao‐E; Wang, Qiang; Zhu, Peipei; Du, Zhipeng; Xia, Chunyan; Qiu, Ming; Zhang, Wei

doi:10.1016/j.ijsu.2017.05.062

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…[8–11,20] In the majority of studies, ectopic thymic parathyroids are almost always inferior and the incidence is reported as between 18%–28%. [5,8–11,16,20] In our study, we detected 18 parathyroids (15%) in the thyrothymic ligament.…”

Section: Limitationssupporting

confidence: 49%

“…In a recent study, a total success in nine cases with SHPT was achieved with a novel surgical method termed “purge parathyroidectomy,” a more extensive method than the classical TPTx + TTLx. [16] However, this technique has not been tested in other studies and a similar success has yet to be repeated. When we look at the literature, the percentage of cases where four glands are resected together is reported as between 72% and 98.5% according to the series.…”

Section: Discussionmentioning

confidence: 99%

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Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy

Uslu¹,

Okut²,

Tercan³

et al. 2019

Medicine

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The normal distribution of parathyroid glands is well documented. However, this study aims to evaluate the efficacy of total parathyroidectomy (TPTx) and bilateral cervical thymectomy (BCTx) for the treatment of secondary hyperparathyroidism (SHPT) through identifying the location of parathyroid glands with attention to the pattern and frequency of orthotopic and ectopic glands. Between 2013 and 2018, sixty chronic hemodialysis patients with medically refractory SHPT underwent TPTx & BCTx. The adequacy of the operation was defined by the pathological confirmation of at least 4 parathyroid glands, accompanied by an intact parathormone (iPTH) value of <60 pg/mL on postoperative day 1(POD1). Based on their anatomical localizations, four distinct sites were identified for both the upper (Zone I–IV) and lower parathyroid glands (Zone V–VIII). The mean follow-up was 15.2 ± 14.6 months. The mean iPTH values on POD1 were normal in 50 patients, with an average of 11.7 ± 14.4 pg/mL. Ten patients (16.6%) had persistent HPT after the operation, three of whom underwent complementary parathyroidectomy. The surgical success rates after first and second operations were both 83.3%. A total of 235 parathyroid glands were detected. Ninety-two percent of the upper parathyroids were located in Zones I and II. However, almost 28% of the lower parathyroids were ectopic and located in Zones VII and VIII. At least one fourth of the lower parathyroids are ectopic; for this reason, Zones VII and VIII require careful investigation during surgery. For upper parathyroids not found in Zone I–III, total thyroidectomy on the same side is recommended.

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Section: Limitationssupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy

Uslu¹,

Okut²,

Tercan³

et al. 2019

Medicine

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“…In our approach of m-TOEPVA, we modified the purge methods 27 to the transoral access. After transection of the upper pole of the thyroid, we favor seeking and identifying the RLN and protecting the nerve first.…”

Section: Discussionmentioning

confidence: 99%

Successful Modified Transoral Endoscopic Parathyroidectomy Vestibular Approach For Secondary Hyperparathyroidism With Ectopic Mediastinal Glands

Wu¹,

Cheng²,

Chiu³

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Transoral endoscopic parathyroidectomy vestibular approach for secondary hyperparathyroidism (SHPT) is controversial with regard to the time consumed, safety, and feasibility. We present our initial experience with modified transoral endoscopic parathyroidectomy vestibular approach (m-TOEPVA) procedure for SHPT using total parathyroidectomy with autotransplantation. Materials and Methods:We retrospectively reviewed 10 patients with SHPT who underwent the m-TOEPVA procedure from December 2017 to April 2018 at our center.Results: There were a total of 6 male individuals and 4 female individuals with a median age of 58.5 years. Among whom, 5 were on hemodialysis and 5 on peritoneal dialysis. The median length of hospital stay and operative time was 5 (4, 5) days, and 321.5 (302.75, 362.25) minutes, respectively. Successful removal of 4 parathyroid glands was achieved in 8 of 10 patients (80%) and, in 8 patients (8/10, 80%), the intact parathyroid hormone successfully dropped to <300 pg/mL at 3 months postoperatively. Two patients with ectopic parathyroid gland in the superior mediastinum were noted preoperatively by MIBI scan and subsequently had successful removal. Except for 1 patient with prolonged hospital stay (11 d) due to hungry bone syndrome, there were no other major complications.Conclusion: m-TOEPVA by total parathyroidectomy with autotransplantation for SHPT is feasible, safe, and offers optimal cosmetic results. The most valuable part is that m-TOEPVA provides direct visualization and successful removal of the ectopic parathyroid glands in the superior mediastinum.

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“…In addition to parathyroid tissue, the hypothalamus and thymus also express PTH mRNA. During embryonic development, ectopic or supernumerary parathyroid glands may be formed ( 57 ), and the incidence of ectopic parathyroid glands in SHPT patients is 26%. In addition, the number of parathyroid glands is variable, with patients typically presenting with 3 to 8 parathyroid glands ( 1 ).At most ectopic parathyroid glands are found in the thymus, so thorough neck exploration is necessary to reduce the risk of postoperative recurrence and reoperation ( 58 ).…”

Section: Treatment For Hptmentioning

confidence: 99%

“…This involves complete removal of the thyroid cartilage, bilateral carotid sheaths, the fibrofatty tissue around the innominate artery, and complete removal of the parathyroid glands. It has achieved a more durable and reliable effect in terms of controlling PTH levels ( 57 ).…”

Section: Treatment For Hptmentioning

confidence: 99%

Advances in the treatment of secondary and tertiary hyperparathyroidism

et al. 2022

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Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are common and complicated clinical endocrine diseases. The parathyroid glands maintain endocrine homeostasis by secreting parathyroid hormone to regulate blood calcium levels. However, structural alterations to multiple organs and systems occur throughout the body due to hyperactivity disorder in SHPT and THPT. This not only decreases the patients’ quality of life, but also affects mortality. Since current treatments for these diseases remains unclear, we aimed to develop a comprehensive review of advances in the treatment of SHPT and THPT according to the latest relevant researches.

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A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy

Abstract: PPTX involves comprehensive resection of supernumerary and ectopic parathyroid tissues, which may provide a more permanent means of reducing PTH levels.

Cited by 7 publications

References 17 publications

Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy

Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy

Successful Modified Transoral Endoscopic Parathyroidectomy Vestibular Approach For Secondary Hyperparathyroidism With Ectopic Mediastinal Glands

Advances in the treatment of secondary and tertiary hyperparathyroidism

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