Minimally Invasive Parathyroidectomy

Abstract

Our results show that iPTH monitoring may be eliminated in MIP surgery in a carefully selected group of patients who have preoperative, localizing MIBI with concordant US. This potentially allows an increase in operating room efficiency and a decrease in costs while performing MIP.

CaPTHUS Scoring Model in Primary Hyperparathyroidism: Can It Eliminate the Need for ioPTH Testing?

“…Several other authors have come to similar conclusions. (13–15) We did not find evidence to support this however, finding that elimination of ioPTH would have led to the premature conclusion of almost 10% of operations in patients with CaPTHUS ≥3. A very small portion of our sample (5%, or 62 patients of the 1421) had CaPTHUS scores of 4 or 5, and only 1 patient in that small subset of patients had multigland disease.…”

Intraoperative PTH May Not Be Necessary in the Management of Primary Hyperparathyroidism Even with Only One Positive or Only Indeterminate Preoperative Localization Studies

“…Haber et al [17] showed a positive predictive value (PPV) of 100% for concordant imaging, and Zawawi et al [7] found that IOPTH had no additional benefit in 99% of patients with 2 preoperative positive imaging studies, but added an average of 31 min to the operative time. Similarly, Smith et al [18] found success rates of 97% in patients with 2 positive preoperative studies. Another study by Gawande et al reported a marginal benefit added by the use of IOPTH for patients with concordant positive preoperative sestamibi scans and US localization, and they documented a PPV of 99% with 2 concordant studies alone [5].…”

Is intraoperative parathyroid monitoring during minimally invasive parathyroidectomy still justified?

“…Although a previous published study by Riss et al. ( 22 ) demonstrated that IOPTH still needs to be employed in patients with concordant localized SGD, other studies have questioned if IOPTH is truly required in patients with concordantly localized SGD, given that it can increase costs, operative time and conversion rate due to inadequate intraoperative decline ( 17 , 18 , 20 , 29 , 44 ). Even international guidelines have started to leave the decision of the utilization of IOPTH with the surgeon ( 21 ).…”