Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial

Šlepavičius, Algirdas; Beiša, Virgilijus; Janušonis, Vinsas; Strupas, Kęstutis

doi:10.1007/s00423-008-0408-1

Cited by 77 publications

(60 citation statements)

References 24 publications

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“…After one year from the surgical procedure there were no differences in cosmetic and aesthetic satisfaction: MIP was very expensive. 121 Another prospective study shows the same results in terms of curative rate for both MIP and conventional procedure: MIP procedure shows a shorter operative time while calcium levels remain lower in the first four operative days in the group who undergoes the conventional procedure. 122 Patients with persistent or recurrent hyperparathyroidism after initial surgery still remain difficult to treat.…”

Section: Surgical Treatmentsupporting

confidence: 53%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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Section: Surgical Treatmentsupporting

confidence: 53%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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“…33,34 Healing and remodelling is largely completed by 8-12 months 35 so scar evaluation should be delayed until 36 Scar aesthetics improve with time. 36,37 The validity of scar assessment is open to criticism in the majority of the studies reviewed here as thyroidectomy scars were assessed at 1-6 months and only 4 of the 20 studies performed cosmetic assessment at >6 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Short and long-term cosmesis of cervical thyroidectomy scars

Dordea

Aspinall

2016

annals

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INTRODUCTION Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. METHODS A systematic review was undertaken. The MEDLINE ® , Embase™ and Cochrane databases were searched for relevant articles. RESULTS A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. CONCLUSIONS Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal. KEYWORDSThyroidectomy -Minimally invasive video assisted thyroidectomy -Scar -Cosmesis

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“…The causes of recurrent of primary hyperparathyroidism may be parathyroid carcinoma, parathyroid hyperplasia or supernomeroty parathyroid gland adenoma, and very rarely, parathyromatosis. There are three theories regarding the origin of parathyromatosis: 1) it is a low-grade parathyroid malignancy; 2) it results from seeding after the fracture of the parathyroid gland kapsule during surgical removal of a parathyroid neoplasm; or 3) it is an overgrowth of embryologic remains of parathyroid tissue [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Parathyromatosis after parathyroidectomy because of primary hyperparathyroidism: A case report

Beiša

Uselis

et al. 2012

Open Medicine

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Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial

Abstract: Both methods of parathyroidectomy for PHP are safe and effective. Focused exploration (FE) has several advantages: lower postoperative pain, lower analgesic request rate, lower analgesic consumption, shorter scar length, better cosmetic satisfaction rate in a short time period.

Cited by 77 publications

References 24 publications

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Short and long-term cosmesis of cervical thyroidectomy scars

Parathyromatosis after parathyroidectomy because of primary hyperparathyroidism: A case report

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