Parathyroidectomy: Overview of the Anatomic Basis and Surgical Strategies for Parathyroid Operations

Abstract

It is imperative for the surgeon who performs parathyroidectomy to have a thorough understanding of the anatomy and embryology of the parathyroid glands in order to optimize the cure rate for patients with hyperparathyroidism (HPT). Furthermore, all clinicians caring for patients with hyperparathyroidism should be aware of the advancements in preoperative parathyroid localization, intraoperative PTH monitoring and surgical strategies for treatment of hyperparathyroidism. In this chapter, the anatomy and embryology of the parathyroid glands will be reviewed. The available surgical options for treatment of patients with hyperparathyroidism will be addressed, including ''focused'' parathyroidectomy, bilateral neck exploration, radioguided parathyroidectomy, and endoscopic and video-assisted parathyroidectomy. The unique challenge associated with reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism will be outlined. Finally, insight into how to locate a qualified surgeon will be provided and recommendations will be made on what constitutes an appropriate choice of operation for specific patients with primary hyperparathyroidism.

Video assisted thoracoscopic resection of mediastinal ectopic parathyroid glands: A single-center experience

“…One of the biochemical ways to increase the efficiency of surgical treatment is intraoperative monitoring of PTH. It is considered that an MEPTG has been successfully extirpated if the PTH level measured 8 -20 minutes after the removal of the tissue has fallen by more than 50%, as compared to the level before excision [20,21]. If the PTH level does not drop to the desired values, surgical exploration should be continued [22].…”

“…Jedan od načina da se biohemijskim putem poveća efikasnost hirurškog lečenja jeste intraoperativno praćenje PTH-a. Smatra se da je EMPTŽ uspešno ekstirpirana ako je nivo PTH-a izmeren 8 -20 minuta nakon uklanjanja tkiva opao za više od 50%, u poređenju sa nivoom pre ekscizije [20,21]. Ukoliko nivo PTH-a ne padne na željene vrednosti, hiruršku eksploraciju treba nastaviti [22].…”

Diagnostic performance of dual phase 99mTc-MIBI planar and SPECT/CT scintigraphy in primary hyperparathyroidism

“…The rational for MIBI scintigraphy is that this radiotracer is localized in the parathyroid gland as well as in the functioning thyroid tissue but usually washes out from the normal thyroid quicker than from abnormal parathyroid tissue [13].…”