Re‐operation for hyperparathyroidism

Abstract

Re-operative parathyroidectomy can be performed by experienced surgeons with a very high success rate and minimal complications.

Preoperative Selective Venous Sampling for Nonlocalizing Parathyroid Adenomas

“…Unless an endoscopic technique is used, this usually precludes a minimally invasive surgical approach. SVS has been used extensively following failed exploration by Udelsman et al (4,10), Jones et al (1), and Liew et al (13). However, this technique is not routinely used as a preoperative localization technique.…”

Imaging for primary hyperparathyroidism—an evidence-based analysis

“…When the quick-PTH assay was developed, its use during SVS was explored and recommended [87]. Generally high sensitivity values have been found in the primary operation setting (94.7% [88], 87% [89], as well as the reoperative situation (91% [90], 78% [91] and 83% [92], 93% [87]), generally higher than other modalities in all these studies. As sensitivities of sestamibi and US yield similar results in the primary operation setting, this invasive procedure should be reserved for otherwise negative imaging studies, contradictory results, and recurrent HPT [87,93,94].…”

“…If these initial methods fail, one should continue with other modalities. Most authors agree that a thorough investigation should be performed before reoperation, including CT and/or MRT and possibly 11C-methionine-PET [80,83,90,91,96]. SVS is highly recommended by many authors, preferably guided by quick-PTH [87,90].…”

Virtual neck exploration in patients with hyperparathyroidism and former cervical operations

“…Even without localization, the cure rate after bilateral neck exploration was excellent in experienced hands best described by the famous statement of Doppman concerning the value of preoperative parathyroid localization techniques: "The only thing to localize in primary hyperparathyroidism is an experienced surgeon" [1]. Apart from intraoperative parathyroid hormone (PTH) assay, preoperative imaging of parathyroid glands with conclusive results is a prerequisite for minimal invasive parathyroidectomy [2]. Although success rates of primary surgical therapy of hyperparathyroidism reach up to 98% in experienced hands for conventional four-gland surgery and 97% for focused minimally invasive surgery [2], still some patients require reoperation.…”

“…Apart from intraoperative parathyroid hormone (PTH) assay, preoperative imaging of parathyroid glands with conclusive results is a prerequisite for minimal invasive parathyroidectomy [2]. Although success rates of primary surgical therapy of hyperparathyroidism reach up to 98% in experienced hands for conventional four-gland surgery and 97% for focused minimally invasive surgery [2], still some patients require reoperation. Surgery for hyperparathyroidism in scarred tissue is challenging and associated with more complications when compared to patients undergoing initial surgery [4,5].…”