Minimally Invasive Surgery for Primary Hyperparathyroidism

Reeve, T. S.; Babidge, Wendy; Parkyn, Robert; Edis, Anthony J.; Delbridge, Leigh; Devitt, Peter G.; Maddern, Guy

doi:10.1001/archsurg.135.4.481

Cited by 53 publications

(5 citation statements)

References 27 publications

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“…In a previous systematic review of MIP published in the ARCHIVES in 2000, 41 we questioned whether there was sufficient evidence to justify the introduction of MIP into clinical practice. In conclusion, it would seem as if MIP has gained an acceptable place in the armamentarium of endocrine surgeons worldwide.…”

Section: Commentmentioning

confidence: 99%

Worldwide Trends in the Surgical Treatment of Primary Hyperparathyroidism in the Era of Minimally Invasive Parathyroidectomy

Sackett¹

2002

Arch Surg

283

182

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Section: Commentmentioning

confidence: 99%

Worldwide Trends in the Surgical Treatment of Primary Hyperparathyroidism in the Era of Minimally Invasive Parathyroidectomy

Sackett¹

2002

Arch Surg

283

182

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“…The remaining 24 patients who preferred a bilateral approach did not undergo MIBI. No persistent or recurrent disease has been noted in this group, and the pathology was as follows: adenoma (19), hyperplasia (two), double adenoma (two), and ectopic adenoma (one).…”

Section: Resultsmentioning

confidence: 72%

“…In most of these studies, however, a suboptimal preoperative localization study was performed or the exclusion criteria were not appropriately applied.V!? Certainly MIP should not be attempted in those patients in whom the history, physical examination, and preoperative localization do not suggest single-gland disease.v" 19 The present study demonstrates that MIP based solely on preoperative MIBI is successful in treating properly selected patients with PHPT. MIBI was highly successful (89%) in identifying and locating an adenoma in our series, and 44 of 47 (93.6%) patients were cured after a directed exploration.…”

Section: Primarymentioning

confidence: 62%

Minimally Invasive Parathyroidectomy without Intraoperative Localization

Sprouse

Roe

Kaufman

et al. 2001

The American Surgeon

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Minimally invasive parathyroidectomy (MIP) is gaining popularity as an alternative to traditional bilateral exploration for patients with primary hyperparathyroidism. The success of MIP relies on the ability of preoperative and intraoperative localization studies to guide a directed exploration for resection of a diseased gland. We hypothesize that excellent results can be achieved with MIP when only technetium-99m sestamibi (MIBI) is used for localization. We conducted a prospective analysis of all patients presenting with a biochemical diagnosis of primary hyperparathyroidism between January 1997 and November 2000. Patients meeting inclusion criteria were given a choice of MIP and directed exploration versus traditional bilateral exploration. Fifty patients chose MIP. Three patients who chose MIP had a negative MIBI, which left 47 patients in the primary study group. The MIBI correctly identified a parathyroid adenoma in 42 patients (89.3%). In two other patients MIBI was inaccurate; however, directed exploration was successfully converted to a bilateral exploration. Overall 44 of 47 (93.6%) patients in the study group were rendered normocalcemic after the initial operation. Three patients experienced persistent hypercalcemia and subsequently underwent successful bilateral exploration. Including those patients choosing a bilateral exploration, a total of 59 positive MIBI scans were evaluated. There were 54 true positives (positive predictive value 91.5%), and if all patients had chosen a MIP 94.9 per cent would have been successfully treated at the initial operation. Mean operative time for MIP was 54.6 minutes, and in 32 patients (68.1%) MIP was performed with local anesthesia and sedation. Twenty-six patients (55.3%) were discharged the same day of the procedure. There were no significant complications in any group analyzed. We conclude that MIP can be successfully performed on the basis of a positive MIBI scan. The present study highlighting many of the advantages of MIP questions the necessity of additional adjuncts such as intraoperative parathyroid hormone measurement and γ-probe localization.

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“…It has been suggested that a reasonable strategy would be to use one or the other imaging methods initially and then to follow with the alternate method if the first test is negative. It has been pointed out that there is a selection bias in most reported series of MIP and that the operation has been scan-selected rather than scan-directed (39). In the only published randomized study the cases were scan-selected (40).…”

Section: Surgical Strategies Preoperative Localization Minimally Invmentioning

confidence: 99%

“…It has been pointed out that there is a selection bias in most reported series of MIP and that the operation has been scan-selected rather than scan-directed (39). In the only published randomized study the cases were scan-selected (40).…”

Section: Serum Calcium Biannually Serum Creatinine Biannuallymentioning

confidence: 99%

Primary Hyperparathyroidism. Update on Pathophysiology, Clinical Presentation and Surgical Treatment

Farnebo

2004

Scand J Surg

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The most important step in calcium homeostasis is the regulation of parathyroid hormone (PTH) secretion. The discovery and characterization of the calcium sensing receptor (CaR) of the parathyroid cell has led to a better understanding not only of the physiology of the parathyroid glands, but also of the development of hyperparathyroidism. Drugs acting on CaR can now be designed to treat hyperparathyroidism and osteoporosis.The workshop on primary hyperparathyroidism held at the National Institutes of Health in 2002 has recommended new guidelines for the treatment of asymptomatic hyperparathyroidism. Controversy still exists regarding the treatment of patients with nonclassical symptoms, such as weakness, fatigue and depression. Primary hyperparathyroidism as a risk factor for cardiovascular disease and mortality is also debated.Improved techniques for the preoperative localization of pathological parathyroid glands have led to a shift in surgical strategy: surgeons abandon the traditional bilateral neck exploration in favor of a more limited approach. This change of strategy has not been based on the results of prospective randomized studies and the long term results are not known.

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Minimally Invasive Surgery for Primary Hyperparathyroidism

Cited by 53 publications

References 27 publications

Worldwide Trends in the Surgical Treatment of Primary Hyperparathyroidism in the Era of Minimally Invasive Parathyroidectomy

Worldwide Trends in the Surgical Treatment of Primary Hyperparathyroidism in the Era of Minimally Invasive Parathyroidectomy

Minimally Invasive Parathyroidectomy without Intraoperative Localization

Primary Hyperparathyroidism. Update on Pathophysiology, Clinical Presentation and Surgical Treatment

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