Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: Modification of a traditional operation

Abstract

BackgroundWe describe a modification of the conventional subtotal parathyroidectomy operation where the parathyroid gland(s) remnant is repositioned with intact vascular supply to a plane superficial to the infrahyoid strap muscles and immediately under the skin incision. This technique called Subtotal Parathyroidectomy and Remnant Relocation (SPARE) retains all the metabolic advantages of the conventional operation with the added advantage of easier identification of a recurrent hyperplastic remnant if re-exploration becomes necessary.MethodsIn the SPARE technique, four parathyroid glands were identified and the quality of each gland and the length of each vascular pedicle to the parathyroid glands were assessed. The optimal parathyroid gland was relocated to a plane superficial to the strap muscles. The remainder of the glands were removed.ResultsIn total, 30 patients with hyperparathyroidism secondary to renal failure (HSRF) underwent parathyroidectomy with the SPARE technique. The mean age was 53.1±12.5 years and median follow-up was 17.1 months (range 1-78.9 months). There were no recurrent laryngeal nerve (RLN) injuries or hematomas. The pre- and post-operative value for corrected calcium and PTH were 158.4±109.4 pmol/L and 11.4±12.1 pmol/L, respectively (p < 0.05). Three recurrences were noted (10.0%), with a mean time to recurrence of 15.3±6.6 months. One patient had excision of the remnant parathyroid glands performed under local anaesthetic (29 min); one had re-exploration performed under general anaesthetic (81 min), and one was managed medically.ConclusionWe described a novel parathyroidectomy technique for patients with HSRF, which provides the advantages of conventional subtotal parathyroidectomy while mitigating the challenges of thyroid bed re-exploration when recurrences arise.

Application of real time shear wave elastography to the differential diagnosis of secondary parathyroid hyperplasia and adenoma

“…The former mainly involves subtotal resection or total parathyroid resection + autologous transplantation combined with double neck exploration, whereas the latter mainly involves single-gland resection. [ 9 ] Therefore, more accurate preoperative positioning and a precise qualitative diagnosis are required to select surgical methods to reduce or avoid postoperative complications.…”

Therapeutic efficacy of two surgical methods on the secondary hyperparathyroidism

“…SPTX is a relatively old surgical method, in which the parathyroid gland weighing 40-50 mg is preserved (13), but this method has been criticized by some experts due to the high recurrence rate (14). In recent years, some studies have reported that the efficacy of removal of 3 parathyroid glands plus 3/4-7/8 of remaining parathyroid gland is superior to that of traditional method (15). There is still no consensus on this issue in China, and the size of residual parathyroid gland ranges from 1/8 to 1/2 of the smallest parathyroid gland (16).…”

Advances in the treatment of secondary and tertiary hyperparathyroidism

“…Some scholars have proposed the “subtotal parathyroidectomy and relocation of remnants,” which refers to the removal of all hyperplastic parathyroid glands and repositioning of a small portion (50 mg) of vascularized parathyroid tissue on the muscular surface of the subhyoid band, below the skin incision, which has a good supply of blood vessels. This not only preserves the ability of the residual glands to continue to secrete PTH and reduces the probability of postoperative complications, but also does not require re-exploration after recurrence, and thus, avoids damage to the recurrent laryngeal nerve ( 56 ).…”