Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe

Hacıyanlı, Mehmet; Genç, Hüdai; Damburacı, Nurullah; Örük, Gonca; Tutuncuoglu, Pelin; Erdoğan, Nuri

doi:10.4103/0022-3859.58925

Cited by 15 publications

(17 citation statements)

References 3 publications

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“…19,20 Several series of parathyroidectomy have been reported without the use of IOPTH measurement. Haciyanli et al found success with a similar approach to ours in a series of 47 patients 21 and Sakimura et al reported their experience of 60 patients. 22 Our experience of 180 cases represents a large series of patients providing further evidence that IOPTH measurement can be safely excluded from focused parathyroidectomy.…”

Section: Collar Incision 10mentioning

confidence: 79%

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Pafitanis

et al. 2015

annals

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INTRODUCTION Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. METHODS Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. RESULTS Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. CONCLUSIONS This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

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Section: Collar Incision 10mentioning

confidence: 79%

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Pafitanis

et al. 2015

annals

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“…7 The most common preoperative localization techniques are the sestamibi scan and the high resolution ultrasonography of the neck with a high sensitivity and specificity reaching 80 to 90%.The sensitivity increases to values as high as 95-97%, when both of these techniques are concordant. 5,8,9 Many centers nowadays perform MIP with a 97-98% success rate without using any intraoperative adjuncts. 3,5,9 Traditional use of perioperative or intraoperative gamma probe or IOPTHA to confirm the adequacy of resection have not increased the success rate for single gland disease when sestamibi and ultrasound were concordant, even in high volume endocrine surgery centers.…”

Section: Discussionmentioning

confidence: 99%

“…5,8,9 Many centers nowadays perform MIP with a 97-98% success rate without using any intraoperative adjuncts. 3,5,9 Traditional use of perioperative or intraoperative gamma probe or IOPTHA to confirm the adequacy of resection have not increased the success rate for single gland disease when sestamibi and ultrasound were concordant, even in high volume endocrine surgery centers. 3,[9][10][11][12] In our study, the CT and MRI scan have been successful in localizing the diseased parathyroid in only three cases, in both of which a giant parathyroid was found.…”

Section: Discussionmentioning

confidence: 99%

“…Its only major disadvantage involves the risk of missing possible multiglandular disease or a second adenoma. 2,5,6 The success of MIP depends on the preoperative accurate visualization of the diseased parathyroid gland. 7 The most common preoperative localization techniques are the sestamibi scan and the high resolution ultrasonography of the neck with a high sensitivity and specificity reaching 80 to 90%.The sensitivity increases to values as high as 95-97%, when both of these techniques are concordant.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Better localization techniques and familiarization with minimally invasive surgery have defined MIP as a safe and effective procedure with excellent cure rates when conducted in experienced hands (>96%), similar to those for traditional bilateral neck exploration. 4,5 MIP is a general term that includes mini incision focusing procedures under local or general anesthesia, video-assisted and endoscopic parathyroidectomy with or without intraoperative gamma probe or IOPTHA. The mini incision focused approach is the current method of choice for the majority of members of the International Association of Endocrine Surgeons.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive parathyroidectomy in patients with previous neck surgery

Dimas¹,

Michas²,

Christakis³

et al. 2012

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ObJEctIVE: Previous neck surgery (PNs) in patients with primary hyperparathyroidism (PHP) is considered as a contraindication for minimally invasive parathyroidectomy (MIP). the purpose of our study was to determine the effectiveness of MIP in such patients. DEsIGN: From January 2003 to June 2011, 380 patients with PHP were treated in our department; 42 had had previous neck surgery. twenty-seven (27/42) were selected to have MIP; the remaining 15 patients had traditional neck explorations. selection criteria for MIP were unilateral single or two gland disease localized preoperatively with at least two imaging techniques and patient's informed consent. Imaging studies included high resolution neck ultrasound and sestamibi scan in the majority, and ct scan, selective venous sampling and MrI in seven patients. the type of operation done included unilateral approach under local anesthesia (UALA) (22 cases) with one conversion to general anesthesia and minimally invasive parathyroidectomy under general anesthesia (MIPG) (5 cases). rEsULts: twenty-six of the 27 patients became normocalcemic after the operation. the patient with persistent hypercalcemia underwent successful parathyroidectomy 8 months later via mesothoracoscopy, since the parathyroid gland was localized correctly but was beyond access via neck. A single adenoma was found in 21 cases and hyperplasia in six. there were no conversions to traditional exploration and no postoperative complications. Mean duration of the procedure and length of stay were similar to MIP in patients without PNs. Mean follow-up of 40 months (4-89 months) did not reveal any recurrence. cONcLUsION: these results illustrate that MIP is a valuable option in selected patients with PHP and PNs associated with no morbidity (0%), high biochemical cure rate (96.3% in this series) and rapid recovery, while it also substantially lowers the cost of the procedure. Preoperative localization with two or more agreeing imaging techniques eliminates the need for intraoperative sestamibi or qPtH test.

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Surgical Aspects of Primary Hyperparathyroidism

Perrier

Lang

Farias

et al. 2020

Journal of Bone and Mineral Research

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Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non‐localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma. The systematic literature reviews discussed covered (i) the use of intraoperative PTH (ioPTH) for localized single‐gland disease and (ii) the management of low BMD after PTX. Updates based on prospective observational studies are presented concerning PTX for multigland disease and hereditary PHPT syndromes, histopathology, intraoperative adjuncts, localization techniques, perioperative management, “reoperative” surgery and volume/outcome data. Postoperative complications are few and uncommon (<3%) in centers performing over 40 PTXs per year. This review is the first global consensus about surgery in PHPT and reflects the current practice in leading endocrine surgery units worldwide. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe

Cited by 15 publications

References 3 publications

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Minimally invasive parathyroidectomy in patients with previous neck surgery

Surgical Aspects of Primary Hyperparathyroidism

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