Practice Patterns in Parathyroid Surgery: A Survey of Asia‐Pacific Parathyroid Surgeons

Abstract

Background Practice variations exist amongst parathyroid surgeons depending on their expertise and resources. Our study aims to elucidate the choice of surgical techniques and adjuncts used in parathyroid surgery by surgeons in the Asia-Pacific region. Methods A 25-question online survey was sent to members of five endocrine surgery associations. Questions covered training background, practice environment and preferred techniques in parathyroid surgery. Respondents were divided into three regions: Australia/New Zealand, South/South East Asia and East Asia, and responses were analysed according to region, specialty, case volume and years in practice. Results One hundred ninety-six surgeons returned the questionnaire. Most surgeons (98%) routinely perform preoperative imaging, with 75% preferring dual imaging with 99m Tcsestamibi and ultrasound. Ten per cent of surgeons use parathyroid 4DCT as first-line imaging, more commonly in East Asia (p = 0.038). Minimally invasive parathyroidectomy is the favoured technique of choice (97%). Most surgeons reporting robotic or endoscopic approaches are from East Asia. Rapid intraoperative parathyroid hormone is accessible to just under half of the surgeons but less available in Australian/New Zealand (p \ 0.001). The use of intraoperative neuromonitoring is not commonly used, even less so amongst Asian surgeons (p = 0.048) and surgeons with low case load (p = 0.013). Conclusion Dual localisation techniques are the preferred choice of investigations in preparation for parathyroid surgery, with minimally invasive surgery without neuromonitoring the preferred approach. Use of adjuncts is sporadic and limited to certain centres.

The Main Surgical Principles and Techniques In the Management of Primary Hyperparathyroidism

“…[42] Dolayısıyla günümüzde pHPT'nin tedavisinde genellikle MİP uygulanmakta, BBE ise daha az sıklıkta kullanılmaktadır. [43] [13] Paratiroit cerrahisinde diseksiyon, tiroidektomide uygulanan diseksiyonun aksi yönünde, diğer bir deyişle karotis medialinden başlanarak lateralden mediale doğru yapılır. İlgili paratiroide ulaşılmasına yardımcı olabilecek diğer bir yöntem İTA gerektiğinde STA'nın bulunup mediale doğru izlenmesidir.…”

Utility of intraoperative digital scintigraphy in radioguided parathyroidectomy

“…While the results of this study did not demonstrate the same success with IoS as those published in the European studies, we believe there are several reasons for this discrepancy. First, the high prevalence of parathyroid disease in our surgical population 16,17 and our use of preoperative 4DCT, with its high rate of localization, limit the number of truly negative localized cases that are taken to surgery. Furthermore, the operators participating in this study had limited prior experience with IoS, and it is possible that greater familiarity with the technology would have led to better results.…”

Three‐phase four‐dimensional computed tomography as a first‐line investigation in primary hyperparathyroidism

“…1 The primary localization technique in Australia and the Asia-Pacific region is technetium-99 sestamibi scintigraphy (MIBI) with single-photon emission computed tomography (SPECT) and ultrasound. 2,3 Limitations of MIBI scans are false positives, the lack of detailed anatomical depiction and poor detection of multigland disease (MGD). 4 Parathyroid four-dimensional computed tomography (4DCT) as an imaging modality was first described in 2006 by Rodgers et al, consisting of multi-detector acquisition of a non-contrast phase followed by an arterial phase and two additional delayed phases.…”

“…9 Despite multiple studies showing 4DCT as a superior modality to MIBI in primary localization, multiglandular disease, ectopic parathyroid tumours and reoperative cases, uptake amongst surgeons as a first-line modality remains low. 3,6,[10][11][12] A factor in reduced uptake is a perception of a higher radiation dose in 4DCT compared to MIBI, particularly to the radiosensitive thyroid gland. 13,14 Limiting the number of phases used in the 4DCT protocol, while maintaining high accuracy, is therefore desirable.…”

“…When localized, MIP achieves comparable cure rates to bilateral neck exploration (BNE) 1 . The primary localization technique in Australia and the Asia‐Pacific region is technetium‐99 sestamibi scintigraphy (MIBI) with single‐photon emission computed tomography (SPECT) and ultrasound 2,3 . Limitations of MIBI scans are false positives, the lack of detailed anatomical depiction and poor detection of multigland disease (MGD) 4 .…”