Open mini-incision parathyroidectomy for solitary parathyroid adenoma

Abstract

Parathyroid surgery is the acceptable definitive treatment for primary hyperparathyroidism (pHPT) due to parathyroid adenoma. Open mini-incision parathyroidectomy (O-MIP) has an excellent cure rate and minimal morbidity. We aim to demonstrate the safety, efficacy and subjective patient satisfaction of O-MIP and investigate the accuracy of pre-operative radiological localisation in relation to operative findings. A retrospective review of patients who underwent O-MIP for pHPT due to solitary parathyroid adenoma from April 2006 to August 2012 was performed. All patients were initially investigated by an endocrinologist to confirm pHPT with pre-operative localisation imaging using ultrasound scan (USS) and 99mTc-sestamibi (MIBI). One hundred and fifty consecutive patients were included with a median age of 62 years. Pre-operative USS and MIBI scans were concordant in 71 % of cases. In combined modality (USS and MIBI), localisation was 94.8 % accurate. There was 95.5 % identification of parathyroid tissue confirmed by intra-operative frozen section. Ninety-one percent of patients were treated as a day case. The median operative time was 60 min. The mean pre-operative calcium level was 2.98 mmol/l, and the short-to-medium term mean calcium level was 2.49 (Paired t test, p < 0.001). There was no significant complication. O-MIP confers significant advantages over the traditional gold standard treatment of bilateral neck exploration. Accurate localisation is the key to successful O-MIP. In experienced hands, ultrasound and MIBI may be the only pre-operative investigations required for accurate localisation.

Open mini-incision parathyroidectomy for solitary parathyroid adenoma: surgical limitations

“…We read with interest the paper titled ''Open mini-incision parathyroidectomy (O-MIP) for solitary parathyroid adenoma'' by Kelly et al [1], whose work shows that O-MIP confers significant advantages over the traditional gold standard treatment of bilateral neck exploration. In our surgery clinic, open mini-incision parathyroidectomy is a prefered and well-known procedure in the treatment of solitary parathyroid adenoma.…”

Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early‐phase Technetium‐99m sestamibi scan

“…A number of different imaging modalities have been investigated to localize adenomas, including neck ultrasound, radionuclide scintigraphy, computed tomography, magnetic resonance imaging (MRI) and positron‐emission tomography (PET). Among these, radionuclide scintigraphy utilizing Tc‐99m sestamibi gained the most popularity, followed by neck ultrasound . Tc‐99m sestamibi as an agent to detect parathyroid adenoma was first introduced by Coakley in 1989 .…”

“…Some groups had reported higher than 90% sensitivity of the Tc‐99m sestamibi scan for preoperative parathyroid adenoma localization with or without SPECT/CT, while others reported widely varying sensitivity of 41–86% . A number of technical and biological factors as well as the experience of the interpreting physician may affect the interpretation of the scan.…”

“…Among these, radionuclide scintigraphy utilizing Tc-99m sestamibi gained the most popularity, followed by neck ultrasound. 10,11 Tc-99m sestamibi as an agent to detect parathyroid adenoma was first introduced by Coakley in 1989. 12 A dual-phase single agent technique was introduced by Taillefer in 1992, based on the observation that Tc-99m sestamibi washes out faster from the thyroid gland than from parathyroid adenoma.…”

Scan-directed mini-incision focused parathyroidectomy: how accurate is accurate enough?

“…[15][16] The patient was positioned and prepared in the standard fashion for any thyroid/parathyroid procedure: this included use of a head ring for increased neck extension to maximise exposure of the surgical field with a slight tilt to the contralateral side. A 2cm incision was made over the anterior border of the sternocleidomastoid muscle at the predetermined level according to the likely position of the affected parathyroid gland.…”