Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

Abstract

Primary hyperparathyroidism (PHPT) is the third most frequent disease among the endocrine disorders, with a prevalence of 1-3% in western countries. Moreover, it is the commonest cause of hypercalcemia (1-4). Nowadays, the PHPT is diagnosed increasingly due to the improvement of biochemical test; it allowed the precocious diagnosis and the identification of asymptomatic patients (5, 6). Conventional bilateral neck exploration remains the reference surgical technique, although the hyperproduction of the parathyroid hormone (PTH) is due to a single hyperfunctioning gland (most frequently a parathyroid adenoma) in a high percentage (70-95%) of cases. It could allow to perform a minimally invasive "focused" approach if the preoperative diagnosis of localization is not doubtful, especially in the presence of two concordant imaging procedures, such as ultrasounds (US) and 99mTc-Sestamibi Scintigraphy (MIBI) (2, 7-11). This focused approach can be performed under general as well as local anaesthesia and it is widely accepted for the sporadic, non-hereditary, uni-focal form (4). The goal of a minimally invasive approach can also be reached with the minimally invasive video-assisted parathyroidectomy (MIVAP), which is an adaptation of the mini-incision cervical procedures to the video-assisted gasless techniques (9,12,13

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

“…Previously published studies [13,[36][37][38] showed several advantages favouring LA compared to GA in terms of shorter operative room occupation time, similar or shorter operative time, lower request for post-operative analgesics, and similar post-operative outcomes. Moreover, Melfa et al [38] analysed the cost of parathyroidectomy in our healthcare system. The Italian Healthcare System's reimbursement is based on the Diagnosis Related Groups (DRGs) system, adopted by the specific regional governance.…”

Letter to the Editor regarding “Does it have a negative economic impact the intraoperative parathyroid hormone assay in primary hyperparathyroidism?”

“…It has been noted previously that MIVAP is more expensive than "open" parathyroidectomy with the patient under local anesthesia due, among other things, to the longer operative time. 2 Group A had 2 patients with bilateral disease (true negatives), whereas group B1 had none.…”

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders

“…The causes previously appealed were orotracheal intubation, changes in laryngeal vascular net, cricothyroid dysfunction, denervation of neck muscles, neck pain or anxiety. The role of the type of endocrine neck disease, the technique used and the extent of surgery play an unclear role in the origin of these symptoms; neither the possible advantages of minimally-invasive techniques have been clarified (5,15,(26)(27)(28)(29)(30)(31)(32)(33). Another possible risk factor for aerodigestive complaints is the intraoperative bleeding (34).…”