Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels

Joliat, Gaëtan‐Romain; Demartines, Nicolas; Portmann, Luc; Boubaker, Ariane; Matter, Maurice

doi:10.1007/s00423-015-1358-z

Cited by 11 publications

(5 citation statements)

References 41 publications

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“…As also reported in other series [13], we observed less frequent episodes of nausea and vomiting when LA was used. We registered only two cases of post-operative complications: a case of transient nerve palsy per group, similar to Joliat et al [39] results, reporting 3% post-operative recurrent laryngeal nerve palsy. It is important to note that intraoperative neuromonitoring cannot be performed during LA.…”

Section: Discussionsupporting

confidence: 88%

Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study

Pennestrì,

Procopio,

Prioli

et al. 2024

Surgical Techniques Development

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Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia (GA) by means of propensity score matching (PSM) analysis. Retrospective research of patients who underwent MIVAP between January 2014 and December 2022 was carried out. Patients were divided into two groups based on the anaesthesiologic procedure (LA vs. GA). Overall, 553 patients underwent MIVAP. After PSM, 115 patients in the LA group and 230 patients in the GA group were included. MIVAP under LA was associated with shorter median operative time (16 vs. 35 min, p < 0.001), shorter median operative room occupation time (44 vs. 73 min, p < 0.001), and lesser median post-operative visual analogue scale pain, with comparable post-operative hospital stay and complication rate. MIVAP under LA is a safe and feasible procedure with significant advantages over GA in terms of post-operative pain and operative room occupation time. This last step can finally result in more efficient utilisation of the operative room and the health care system’s resources.

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Section: Discussionsupporting

confidence: 88%

Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study

Pennestrì,

Procopio,

Prioli

et al. 2024

Surgical Techniques Development

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“…The cure rates for a MIP that incorporated both preoperative imaging and intraoperative PTH assessment were as good as or better than the mean published rates for planned BNE with four‐gland dissection (Table ; Fig. ) …”

Section: Resultsmentioning

confidence: 78%

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Walsh

Sullivan

Duke

et al. 2018

Laryngoscope Investig Oto

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Objective Recent advances in preoperative imaging techniques and intraoperative parathyroid hormone (ioPTH) assays have made single‐gland, minimally invasive parathyroidectomy (MIP) the preferred treatment option for most patients with primary hyperparathyroidism (pHPT). Despite this evolution, a recommendation for bilateral neck exploration (BNE) with four‐gland dissection in all patients has recently been advocated by a parathyroid surgical group. The current study compares the long‐term outcomes of MIP with those of conventional BNE with four‐gland dissection in patients with pHPT. Methods In order to objectively assess a recommendation in the literature that universal BNE with four‐gland dissection is advisable, all patients undergoing an initial MIP with ioPTH assessment for pHPT in a tertiary endocrine practice during a 10‐year period were reviewed. The cure rates from this procedure were compared with published results of conventional BNE with four‐gland dissection. Results Of the 561 patients undergoing parathyroidectomy during the study period, 337 had initial surgery for pHPT; 282 of these patients met inclusion criteria and 212 had sufficient follow‐up data available. A single adenoma was identified in 87.3% of cases. Preoperative imaging studies were co‐localizing in 148 (69.8%), and 127 (85.8%) of these patients with co‐localizing imaging required only single‐gland surgery. Imaging studies did not co‐localize in 49 patients, yet 32 (65.3%) of these patients were still cured with unilateral surgery. The cure rate for patients undergoing MIP was 98.6%, with a long‐term recurrence rate of <2%. Conclusion When coupled with the ioPTH assay, patients with at least one preoperative localizing study can undergo MIP and anticipate a cure rate of 99%, which is as good as or better than the published rates for conventional BNE with four‐gland dissection. With unilateral surgery, the risks of permanent hypoparathyroidism and airway obstruction from bilateral vocal fold paralysis are completely eliminated. Therefore, despite recommendations to the contrary, most patients with pHPT should not have a planned four‐gland exploration. Level of Evidence III or IV

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“…The injection of furosemid stimulates PTH secretion in healthy adults (Muller, 2015). The measurement of peroperative intact parathormone levels should be performed during miniinvasive approaches on parathyroid glands (Joliat et al, 2015). This method is associated with a signifi cant decrease of (i) operation time, (ii) length of hospitalization, and (iii) occurrence of complications including not esthetic scarring (Adámek et al, 2005, Libánský et al, 2007.…”

Section: Discussionmentioning

confidence: 99%

Measurement of intact parathormone during operation for primary hyperparathyroidism

Libánský¹,

Adámek²,

Broulík³

et al. 2017

BLL

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In this prospective study, the role of the intact parathormone (iPHT) levels for the verifi cation of pathologic parathyroid tissue removal during parathyroidectomy, was analyzed in 441 patients diagnosed with primary hyperparathyroidism. The level of intact parathormone was obtained before the initial incision (baseline level) and 10 minutes after the pathologic parathyroid gland removal (control value). In 80 % of cases, the decrease of intact parathormone was more than 50 % of the baseline level. The comparison of preoperative and postoperative intact parathormone levels can also be used as marker of parathyroid hyperplasia or persistent hyperparathyroidism. This method is necessary mainly for performance of focused, miniinvasive approaches as well as in reoperations. This method is of signifi cant benefi t in cases of negative preoperative examination methods. The determination of intact parathormone level increases the success of parathyroidectomy (Ref. 26). Text in PDF www.elis.sk.

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Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels

Cited by 11 publications

References 41 publications

Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study

Locoregional vs. General Anaesthesia for Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) Using Propensity Score Matching Analysis: A Feasibility Study

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Measurement of intact parathormone during operation for primary hyperparathyroidism

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