Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Abstract

Primary hyperparathyroidism (PHPT) is defined as symptomatic hypercalcaemia due to excessive parathyroid hormone (PTH) secretion in the absence of secondary or tertiary causes. Surgical management involves parathyroidectomy, which has shown to improve health-related quality of life.1 Conventional surgical practice has been collar incision with bilateral neck exploration and a four-gland evaluation approach.From the early 21st century, minimally invasive techniques of unilateral exploration and evaluation limited to the site of suspected lesion, as directed by preoperative localisation, were developed.2 These include video-assisted parathyroidectomy, endoscopic parathyroidectomy and mini-incision parathyroidectomy.Minimally invasive parathyroidectomy (MIP) showed a lower complication rate, with a reduced hospital stay and cost compared with the conventional approach.3 However, a national survey in the UK and Ireland noted that only 3% of consultant members of the British Association of Endocrine Surgeons were using the lateral incision approach, with the majority preferring the collar incision. 4 Some centres use intraoperative parathyroid hormone (IOPTH) measurements as routine 5 although the role of the IOPTH in parathyroidectomy at this point is questionable. 6Frozen sections are also used occasionally in parathyroid surgery to identify parathyroid tissue and differentiate it from non-parathyroid tissue with good accuracy. 7Our local practice utilises simplified parathyroidectomy. This involves a mini-incision without the routine use of IOPTH measurements and frozen sections. This study aims to demonstrate that a good success rate can be achieved without the use of any intraoperative adjuncts. This simplified technique will hopefully encourage more to undertake minimally invasive parathyroid surgery. Materials and MethodsThe first 100 patients who underwent MIP for PHPT from January 2008 done at a single institution by a single surgeon were recruited prospectively for this study. Preoperatively, patients underwent ultrasonography (US) and/or a 99m Tc-labelled sestamibi (MIBI) scan for localisation. The risks were ABSTRACT inTRodUCTion Conventional practice of parathyroidectomy has been collar incision with bilateral neck exploration and a fourgland evaluation. our local practice involves simplified parathyroidectomy via mini-incision without routine use of intraoperative adjuncts. The aim of this study is to demonstrate that a good success rate can be achieved, which will hopefully encourage more to undertake minimally invasive parathyroid surgery. maTERiaLS and mEThodS a prospective case series of the first 100 patients undergoing minimally invasive parathyroidectomy (miP) by a single surgeon at a single institution were included. Preoperatively, patients underwent ultrasonography (US) and/or a sestamibi (mibi) scan for localisation. Parathyroidectomy was performed following an algorithm of intraoperative decisions. Serum calcium and/or parathyroid hormone levels were checked at follow-up. Postoperative normo...

A 20-Year Study on 190 Patients With Primary Hyperparathyroidism in a Developing Country: Turkey Experience

“…1,15,16,20,22,23 In our study, the symptomatic cases were 72% ( Table 1). The location of our country between the eastern and western countries explains this result.…”

“…5 In the last 30 years, the wide use of the multichannel autoanalyzer; use of USG, MIBI, computed tomography (CT), and MRI for the diagnosis of PHPT; and new surgical methods and techniques for the surgical treatment of PHPT have resulted in easier diagnosis of the disease, correct localization of pathologic lesions, and different surgical approaches. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] The aim of this study was to present our 20-yearexperience with 190 patients diagnosed with PHPT, their clinical features, diagnostic methods, surgical treatment and pathology, and review of the literature.…”

Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy

“…15 Our combination of preoperative marking facilitating a focused minimal dissection and avoidance of intraoperative parathyroid assay has resulted in a shorter operative time (median: 30 minutes) than similar studies employing the focused lateral approach (42.38 minutes). 11 The expedience of this approach is likely to have a cost benefit. Although we have not performed formal cost effectiveness analysis, the gross disparity in pricing between ultrasonography alone and additional cross-sectional imaging, nuclear imaging and/or laboratory testing suggests our protocol may incur significant cost savings by using ultrasonography alone.…”

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

“…Alguns estudos mostraram excelentes resultados (58). Todavia, devem ser vistos com ressalvas, pois o método é válido para tratamento de HPT primário (adenoma) e não do HPT secundário (hiperplasia) que, por definição, é multiglandular.…”