Minimally invasive parathyroidectomy in patients with previous neck surgery

Abstract

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.