Surgical Strategy in Hyperparathyroidism Due to Solitary Adenoma

Abstract

Based on the postulate that parathyroid adenoma is practically always a solitary lesion, unilateral parathyroidectomy including the homolateral normal parathyroid was applied as a principle in the treatment of this form of primary hyperparathyroidism. The exploration was confined to the adenoma side if this was the first to be explored. Intraoperative oil-red-O staining of frozen sections was used to exclude the possibility of a multiglandular involvement. This principle was applied in a consecutive series of 102 patients operated for hyperparathyroidism from 1977 to 1981 and diagnosed as parathyroid adenoma. In 43 patients where the abnormal gland was found on the side explored first, unilateral parathyroidectomy was performed on that side, avoiding exploration of the contralateral side. In 45 patients where normal glands were found on the side first explored, unilateral parathyroidectomy was performed on the contralateral side. In 14 patients other types of operations were performed as the above-mentioned principle could not be achieved. At follow-up 1 to 5 years after surgery, no cases of hypocalcemia were recorded. The results of the different operations were compared as to early and late hypocalcemia. Early hypercalcemia was more pronounced after a bilateral exploration. Two of the patients who had an atypical operation had a permanent need for vitamin D in order to maintain an adequate serum calcium level. Surgical principles for various possible exploratory findings are outlined. These are based upon the idea of performing a unilateral parathyroidectomy whenever intraoperative oil-red-O staining excludes multiglandular involvement as a cause for the hyperparathyroidism.

Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients

“…However, this argument is doubtful, since there is a trend to surgically treat more patients with mild disease and small adenomas, and these patients tend to be more difficult to operate on. Furthermore, bilateral exploration does come at a prize, i.e., an increased risk for early biochemical and medically treated hypocalcemia [23,43].…”

Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations

“…In 43 patients where the abnormal gland was found on the side first explored, unilateral parathyroidectomy was performed on that side. In 45 patients where normal glands were found on the side first explored, the contralateral side was approached [4]. In a further study by the same authors, UNE was applied to 50 patients and compared with another group of 50 conventionally explored patients.…”

Unilateral open and minimally invasive procedures for primary hyperparathyroidism: a review of selective approaches

“…Due to the prevailing SGD, success rates of the unilateral approach were used to promote the method. Documentation of successful practice of unilateral approaches without change in the preconditions of preoperative localization measures and of perioperative control without visualization of the four parathyroids was given by some authors [43][44][45].…”