Conventional bilateral cervical exploration <i>versus</i> open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism

Bergenfelz, Anders; Kanngießer, Veit; Zielke, A.; Nies, C.; Rothmund, M.

doi:10.1002/bjs.4814

Cited by 121 publications

(82 citation statements)

References 30 publications

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“…At present, there is no unambiguous answer to this question. On the other hand, it is a well known fact that in such situations, "overdiagnosing" of multiglandular parathyroid disease leads to a considerable increase in the rate of postoperative hypocalcemia and poses a genuine risk of some patients developing fixed hypoparathyroidism (9,24). Therefore, it seems rational to employ intraoperative iPTH assay also during BNE procedures.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Neck Exploration with Intraoperative iPTH Assay in the ERA of Minimaly Invasive Parathyroidectomy

Barczyński¹,

Konturek²,

Stopa³

et al. 2010

Polish Journal of Surgery

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2Kierownik: dr hab. a. Hubalewska-Dydejczyk At present, the majority of patients with sporadic primary hyperparathyroidism (pHPT) qualify to minimally invasive parathyroidectomy (MIP). Nevertheless, in some patients, especially those with multiglandular parathyroid disease, achieving normocalcemia necessitates bilateral neck exploration (BNE). The aim of the study was evaluation of current indications for BNE and results obtained employing this method in an endocrine surgery referral center. material and methods. A prospective analysis included 385 patients with pHPT qualified to parathyroidectomy (300 to MIP and 85 to BNE procedures) in the period between 12/2002 and 05/2008. Prior to the procedure, all the patients underwent preoperative imaging diagnostic studies (scintiscans of the parathyroids and ultrasound of the neck). Intraoperative parathormone assay was carried out in the course of all the operations. Indications for BNE and therapeutic results were evaluated. Results. The most common indication for BNE was lack of preoperative location of a parathyroid adenoma in imaging studies aiming either at lateralization or regionalization (49.4%), followed by concomitant thyroid pathology that required surgical treatment (23.5%), MEN 1 syndrome (12.9%), long-term lithium therapy (5.9%), refusal of the patient to grant informed consent to a minimally invasive parathyroidectomy (5.9%) and MEN 2A syndrome (2.4%). In the discussed group, 31 subtotal parathyroidectomies were performed, along with ten resections of two parathyroid adenomas and 44 resections of single parathyroid adenomas. Intraoperative iPTH assay affected the extent of parathyroid tissues resection in eight (9.4%) cases. One case of persistent and one case of recurrent hyperparathyroidism were noted in the follow-up of mean 37.4 ± 19.4 months postoperatively. conclusions. In an endocrine surgery referral center, BNE is a procedure of choice in patients suspected of multiglandular parathyroid disease (MEN 1 and 2A, familial pHPT, long-term lithium therapy), in cases when a pathological parathyroid has not been located preoperatively and in patients which refuse their consent to MIP. Supplementing BNE with intraoperative iPTH assay allows for maintaining the highest quality of surgical treatment.

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Section: Discussionmentioning

confidence: 99%

“…This phenomenon is a consequence of preserving intact the blood supply of normal parathyroids, which have not been exposed in the course of MIP. In turn, a lower rate of transient hypocalcemia after MIP is associated with significantly decreased requirements for calcium and vitamin D 3 preparations and shorter hospitalization (9).…”

mentioning

confidence: 99%

Bilateral Neck Exploration with Intraoperative iPTH Assay in the ERA of Minimaly Invasive Parathyroidectomy

Barczyński¹,

Konturek²,

Stopa³

et al. 2010

Polish Journal of Surgery

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“…121 Another prospective study shows the same results in terms of curative rate for both MIP and conventional procedure: MIP procedure shows a shorter operative time while calcium levels remain lower in the first four operative days in the group who undergoes the conventional procedure. 122 Patients with persistent or recurrent hyperparathyroidism after initial surgery still remain difficult to treat. There is more than one cause of failed first treatment: an inexperienced surgeon, the multiple gland disease, an ectopic gland, supernumerary gland, parathyromatosis from spillage after the initial surgical procedure.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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“…These studies have become increasingly important since the introduction of less invasive, imaging-guided surgical techniques [9,10]. The latter has largely replaced conventional surgical procedures (bilateral exploration of the neck) reducing operative times and hospital stay as well as the risk of complications [11].…”

Section: Introductionmentioning

confidence: 99%

Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

et al. 2014

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Objective Primary hyperparathyroidism (PHPT) is a common endocrine disorder that can be cured only by parathyroidectomy. Cervical ultrasonography and scintigraphy are the imaging studies most widely used for preoperative localization of the affected glands. The aim of this retrospective comparative study was to define the respective roles of ultrasonography and parathyroid scintigraphy in these cases. Materials and methods We analyzed 108 patients who had undergone parathyroidectomies for PHPT following cervical ultrasonographic and scintigraphic examinations. The ultrasound examinations were carried out by an expert physician sonographer in 61 cases and by various physician sonographers with different levels of experience in 47 cases. Sonographic and scintigraphic findings were compared with surgical findings and the diagnostic performance of the two imaging methods was evaluated by means of statistical analysis.Results The operator dependency of ultrasonography was confirmed by marked variations in sensitivity related to the experience of the sonographer. When sonography was performed by an expert, the sensitivity of combined use of the two methods was not significantly higher than that of sonography alone. Conclusions In expert hands, the diagnostic yield of ultrasound is appreciably superior. It can therefore be used as the main and possibly sole method for preoperative localization of pathological parathyroid tissues. Combined use of ultrasound and scintigraphy is not cost-effective in these cases. Scintigraphy is indicated only when the ultrasound examination produces negative results.Keywords Primary hyperparathyroidism Á Parathyroid adenoma Á Ultrasonography Á Localization Riassunto Obiettivo L'iperparatiroidismo primitivo (PHPT) è una frequente patologia endocrina che ha come unico trattamento risolutivo quello chirurgico (paratiroidectomia). L'ecografia del collo e la scintigrafia sono gli esami strumentali più comunemente utilizzati nella localizzazione preoperatoria delle paratiroidi patologiche. Scopo di questo studio retrospettivo è definire il ruolo dell'ecografia, confrontandolo con quello della scintigrafia paratiroidea. Materiali e metodi 108 pazienti sottoposti a intervento di paratiroidectomia per PHPT che hanno eseguito pre-operatoriamente sia l'ecografia del collo che la scintigrafia. L'ecografia è stata eseguita in 61 pazienti da un medico ecografista esperto e in 47 pazienti da più medici ecografisti con esperienza eterogenea. Gli esiti dell'ecografia e della scintigrafia sono stati confrontati con le risultanze dell'atto operatorio e i dati relativi alle loro prestazioni diagnostiche sono stati elaborati mediante analisi statistica. Risultati L'ecografia si è confermata metodica operatoredipendente, dipendendo la sua sensibilità in modo marcato dall'esperienza dell'operatore. Nel caso dell'operatore esperto, l'incremento di sensibilità ottenuto con il contemporaneo uso della scintigrafia si è dimostrato poco rilevante. Conclusioni Se eseguita da un operatore esperto, l'ecografia ...

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Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism

Abstract: Targeted MIP using local anaesthesia reduces operating time and causes less postoperative biochemical hypocalcaemia compared with bilateral neck exploration.

Cited by 121 publications

References 30 publications

Bilateral Neck Exploration with Intraoperative iPTH Assay in the ERA of Minimaly Invasive Parathyroidectomy

Bilateral Neck Exploration with Intraoperative iPTH Assay in the ERA of Minimaly Invasive Parathyroidectomy

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

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