Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism

Abstract

Context. Primary hyperparathyroidism (PHPT), characterized by the inappropriate secretion of parathyroid hormone (PTH) with respect to the extracellular calcium concentration. Curative treatment of PHPT is surgery and bilateral neck exploration has been replaced by minimally invasive parathyroidectomy (MIP), with the advanced imaging technologies combined with radio-guided occult lesion localization (ROLL). Objectives. The present study analyzes the MIP data from 45 patients who underwent surgery for parathyroid adenoma and debates if MIP is a feasible technique for the treatment of PHPT. Design. The study presents the MIP excision data of 45 hyperparathyroidism patients with a 58-month follow up period. Results. Forty-five operations were performed for 48 parathyroid adenomas. The mean duration of operation was 22.7 (12-55) minutes. Mean follow-up was 14.2 (6-26) months. All patients had normal postoperative calcium levels and PTH levels were normal in the follow-up period, except for one persistent hyperparathyroidism. Conclusions. ROLL-guided MIP is a feasible technique for parathyroid surgery and reduces surgeon based failure. It also provides the widespread application of parathyroid surgery by decreasing the need for specific experience.

Safe Method for the Treatment of Primary Hyperparathyroidism in Geriatric Patients: Minimally Invasive Parathyroidectomy

“…The success rate of detection and removal of adenoma was found to be high with MIP (minimal invazive parathyroidectomy) using gamma probe. In addition, the radioactive material given for gamma probe was considered to be within the safe range when the level of absorbance in normal tissues was evaluated; compared to many other radiological examinations, it is considered to be at very low levels 16 .…”

“…If the blood PTH level decreases by 50% after the operation, it is decided that the adenoma is removed successfully 8,16 . In our study, parathormone levels decreased significantly in the early postoperative period compared to the preoperative levels, especially in the group≥65 years, statistically significantly lower than the other group PTH levels in both early postoperative and postoperative 1st month.…”

Primary Hyperparathyroidism: To Evaluate Benefit of Ultrasound and Tc99m-SESTAMIBI Scan in Localizing Abnormal Parathyroid Gland Before Surgery, in a Secondary Care Hospital

“…MIP is preferred over four-gland exploration surgery as neck dissection is less, scar is small, less operative time, shorter duration of stay, low risk of recurrent laryngeal nerve injury compared to four-gland exploration [10,11]. For MIP abnormal parathyroid gland localization before surgery is important for which two investigative modalities are used commonly i.e.…”

The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

“…Bilateral intraoperative neck exploration to identify and remove the hyper-functioning parathyroid tissue is the gold standard for the treatment of PHPT. However, the surgical approach of choice is minimally invasive parathyroidectomy (MI ptx) since the precise localization of the parathyroid lesion has become possible by imaging [ 8 ]. Preoperative localization of the parathyroid lesion is critical to identify suitable candidates for MI ptx, which results in a reduction of the invasiveness of the surgical technique [ 3 ].…”