A Comprehensive Evaluation of Perioperative Adjuncts During Minimally Invasive Parathyroidectomy

Chen, Herbert; Mack, Eberhard; Starling, James R.

doi:10.1097/01.sla.0000179622.37270.36

Cited by 204 publications

(154 citation statements)

References 26 publications

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“…A study by Sosa et al [58] demonstrated that surgeon experience determined the length of stay and number of complications and that hospital volume was not consistently associated with outcomes. If undertaken by an experienced endocrine surgeon, minimally invasive parathyroidectomy is an ideal operation if preoperative imaging localizes an adenoma, otherwise bilateral neck exploration is undertaken [59].…”

Section: Surgicalmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels. These patients often do not fall into the criteria for operation based on the National Institutes of Health consensus guidelines, and they can present a challenge of diagnosis and management. The purpose of this paper is to review the available literature on mild pHPT in an effort to better characterize this patient population and to determine whether patients benefit from parathyroidectomy. Evidence suggests that there are patients with mild pHPTwho have overt symptoms that are found to improve after parathyroidectomy. There is also a group of patients with biochemically mild pHPT who are found to progress to classic pHPT over time; however, it is not predictable which group of patients this will be. Early intervention for this group with mild pHPT may prevent progression of bone, psychiatric, and renal complications, and parathyroidectomy has proven safe in appropriately selected patients at high volume centers. The Oncologist 2014;19:919-929 Implications for Practice: Mild primary hyperparathyroidism (pHPT) is a disease that is being diagnosed with increased frequency; however, recommendations for treatment are not uniform. Current NIH guidelines do not recommend parathyroidectomy for these patients if they are asymptomatic; however, upon focused questioning, many of these patients are found to have subtle symptoms.The biochemically mild nature of the disease has been found to delay diagnosis and treatment, but after it is identified, surgery has shown to provide an improvement in quality of life and bone health. Although the current body of literature suggests that patients with mild pHPT benefit from parathyroidectomy, careful patient and surgeon selection is critical to ensuring safety and efficacy. Universal acceptance of parathyroidectomy in this subset of patients will require more high quality, prospective studies and improved definitions of long-term cure.

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Section: Surgicalmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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“…Therefore investigators have tried to identify acquisition schemes by using a combination of unenhanced and multiple postcontrast phases including 2 [25][26][27] with the time interval ranging from 30 to 90 seconds, each with strengths and limitations.…”

Section: Discussionmentioning

confidence: 99%

“…1 Definitive treatment requires surgical excision, and preoperative localization with imaging is commonly used to decrease the size of surgical incisions and complication rates. 2 Imaging has been increasingly used for preoperative detection of parathyroid adenomas. While sonography and technetium Tc99m sestamibi scintigraphy have often been used as first-line imaging to localize PTA, these tests are often inconclusive.…”

mentioning

confidence: 99%

Dynamic 4D MRI for Characterization of Parathyroid Adenomas: Multiparametric Analysis

Nael

Hur

Bauer

et al. 2015

AJNR Am J Neuroradiol

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“…The success of MIP can be improved with techniques such as radioguidance and intraoperative PTH (ioPTH) monitoring that confirm the intraoperative localization of abnormal glands (27). A radioguided parathyroidectomy involves preoperative intravenous injection of technetium-99m sestamibi 1-2 hours prior to the operation and use of a handheld gamma probe intraoperatively to localize hyperfunctioning parathyroid glands.…”

Section: Parathyroidectomymentioning

confidence: 99%