Minimally invasive surgery for primary hyperparathyroidism: a systematic review

Abstract

The proposed role of minimally invasive parathyroid surgery is for patients with primary hyperparathyroidism who have unilateral parathyroid pathology. To assess the safety and efficacy of minimally invasive techniques it is suggested that their introduction be monitored as part of a trial in Australia, from which data should be accrued to a register.

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

“…Furthermore, some difficulties and complications should be remembered when neck surgery by minimally invasive techniques is performed. The first of these concerns the removal of parathyroid adenoma through a small incision or through an endoscopy port or cannula, because it provides a risk for rupture of the adenoma, which can lead to parathyromatosis [1]. Parathyromatosis is a rare cause of hyperparathyroidism.…”

“…The most common reasons for conversion are: inability to visualise the adenoma, bleeding, and incorrect localisation by the sestamibi scans [1].…”

“…Despite the success of the traditional surgical approach to parathyroid disease, an alternative approach that minimises the disability associated with surgery is always desirable. In recent years, radio-guided [5], endoscopic and video-assisted gasless techniques [1] have been used to develop a minimally invasive approach to surgery for primary hyperparathyroidism in order to limit patient discomfort, shorten convalescence, and, most importantly, improve the cosmetic result [3,4]. In the setting of minimally invasive parathyroidectomy, pre-operative localisation of abnormal parathyroid tissue is absolutely mandatory.…”

“…Contraindications for the minimally invasive technique include [1,3,4,18]: -the presence of multiglandular disease; -the presence of multiple endocrine neoplasia, malignancy [48]; -the presence of concomitant thyroid disease (relative); -previous neck surgery or irradiation of the neck; -nodular goitre; -lithium associated primary hyperparathyroidism; -failure to localise the adenoma preoperatively; -unfavourable surgical anatomy.…”

“…The operation was performed under local anaesthesia; four parathyroid glands were identified, and a single enlarged parathyroid was excised. Since that time, the diagnostics and management of parathyroidism including surgery have been developed, resulting in a satisfactory outcome in 95-98% of operated patients [1,2].…”