Surgical management of primary hyperparathyroidism – results of a national survey

Özbaş, Serdar; Pain, Simon; Tang, Tong; Wishart, Gordon

doi:10.1308/003588403766274926

Cited by 16 publications

(13 citation statements)

References 42 publications

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“…15 Although a survey of members of the International Association of Endocrine Surgeons in 2002 illustrated a general adaptation towards the focused mini-incision approach worldwide, 13 uptake of this technique in the UK and Ireland is poor, with 97% of surgeons still adopting the bilateral neck exploratory approach. 4 MIP has been shown to be the superior approach. There is a two-fold higher complication rate (3.0%) in the conventional approach compared with that in MIP (1.2%) although the risk of ipsilateral recurrent laryngeal nerve injury is similar (0.7% and 0.8% respectively).…”

Section: Discussionmentioning

confidence: 99%

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

Wong

et al. 2011

annals

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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...

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Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Wong

et al. 2011

annals

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“…Dennoch werden Nebenschilddrüsenopera-tionen nicht nur bei konventionell-offenem, sondern auch bei minimal-invasivem Vorgehen in den meisten Kliniken, so auch in der eigenen Klinik, selbst bei sicher erfolgreicher Parathyreoidektomie aufgrund des nicht selten postoperativ länger als bei Schilddrüsenoperationen dauernden Intervalls bis zur Normalisierung des Kalziumstoffwechsels meist konventionell-stationär behandelt [9,10,14,19,32,40,72]. Allerdings ist auch hier in den letzten Jahren,zumindest bei unkomplizierten Parathyroidektomien, in zahlreichen,vorwiegend US-amerikanischen Kliniken, z. T. aber auch in Europa ein Trend zur Ein-Tages-Chirurgie festzustellen [7,9,14,17,18,23,38,40,79].…”

Section: Nebenschilddrüsenoperationenunclassified

Ambulante und kurzzeitstation�re Schilddr�sen- und Nebenschilddr�senchirurgie

et al. 2004

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Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery.

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“…Thus, bilateral cervical parathyroid exploration relies only on the technical skill and clinical acumen of the surgeon and can be performed in virtually any hospital around the globe. Most parathyroid surgeons in many parts of the world continue to employ routine bilateral neck exploration for surgical parathyroid disease [76,77].…”

Section: Bilateral Explorationmentioning

confidence: 99%