The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery

Abstract

INTRODUCTION Surgery is the first-line management option for patients with primary hyperparathyroidism (pHPT). Minimally invasive parathyroidectomy (MIP) is now preferable but few centres offer this service, mainly because of lack of intraoperative parathyroid hormone (IOPTH) testing. The aim of this study was to identify whether the measurement of IOPTH in patients having minimally invasive parathyroidectomy for pHPT alters their management. METHODS A retrospective review was carried out of 78 consecutive patients who underwent parathyroid surgery by a single surgeon with a special interest in parathyroid surgery. The clinical impact of IOPTH monitoring was recorded postoperatively in a timely manner. Serum adjusted calcium levels were checked preoperatively (on admission) and one month postoperatively; normalisation was considered a cure. RESULTS In the setting of curative MIP, IOPTH measurement did not influence the management in any of the patients but it could have led to bilateral parathyroid exploration (BPE) in three instances. Similarly, in cases that required lengthening of the MIP incision, IOPTH results did not influence patient management although it could have led to BPE in one case. CONCLUSIONS MIP offers an effective cure for patients with hyperparathyroidism. The addition of IOPTH testing adds increased expense, operating time and risk to patients otherwise suitable for MIP.

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

“…Clearer understanding is important because intraoperative decisions can change based on IOPTH monitoring, which may lead to unnecessarily extended anesthetic exposure and surgical explorations. 14 Recent studies have investigated various factors that may alter PTH metabolism and thus the utility of IOPTH monitoring. 15e17 The objective of this study was to evaluate the kinetics of IOPTH decrease during parathyroidectomy in patients with chronic kidney disease and to assess whether the Miami criterion can be appropriately applied to this patient population.…”

Evaluating a shortened interpretation criterion for intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism: 5‐minutes criterion in primary hyperparathyroidism and intraoperative algorithm

“…[21][22][23] However, as published previously, IOPTH seems necessary to avoid persisting disease due to the decreased reliability of preoperative localization studies in an endemic goiter region. [21][22][23] However, as published previously, IOPTH seems necessary to avoid persisting disease due to the decreased reliability of preoperative localization studies in an endemic goiter region.…”

“…There is an ongoing discussion whether IOPTH is necessary in patients with presumed localized single-gland disease. [21][22][23] However, as published previously, IOPTH seems necessary to avoid persisting disease due to the decreased reliability of preoperative localization studies in an endemic goiter region. 1 This has been confirmed by Rajaei et al 24 As also discussed by Alhefdhi et al, discontinuation of surgery 5 minutes earlier does not reduce the costs for IOPTH, as the number of blood samples stays the same.…”

Management of severe and symptomatic primary hyperparathyroidism in the first trimester of unplanned pregnancy

“…The patient tolerated the procedure very well and was pleased to have avoided general anaesthesia. No intra-operative PTH measurement was undertaken as this was not part of the routine practice of the centre and not recommended by NICE guidance for first-time parathyroid surgery due to increased expenditure, operating time, and risk to patients otherwise suitable for minimally invasive parathyroidectomy ( 11 , 12 ).…”