Subtotal Parathyroidectomy for Primary Hyperparathyroidism

Paloyan, Edward; Lawrence, A. M.; Oslapas, Raymond; Shah, Kishor H.; Ernst, K; Hofmann, Cecilia

doi:10.1001/archsurg.1983.01390040037008

Cited by 29 publications

(5 citation statements)

References 34 publications

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“…This new policy f rainimal approach is supported by the following arguments: irst, in about 80% to 90% of patients the PHP is associated ~ith a single adenoma and removal of this sole pathologic gland Is sufficient to achieve the cure of the illness. The identification of all parathyroid glands may be questionable and sometimes eXCessive resection or biopsy from normal glands may be ~ e!rimental and may increase recurrent laryngeal nerve mor-I~lty and/or hypoparathyroidism [23]. Moreover, even experienced parathyroid surgeons do not always identify all parathyroid glands in all patients.…”

Section: Resultsmentioning

confidence: 99%

Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH

Chapuis

Fulla

et al. 1992

World j. surg.

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Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Resultsmentioning

confidence: 99%

Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH

Chapuis

Fulla

et al. 1992

World j. surg.

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“…Paloyan et al [ 58 ] published long term results in 292 consecutive patients who underwent subtotal parathyroidectomy for primary hyperparathyroidism and found that 97.6% were cured after their first operation. A more recent study compared whole vs partial gland remnant for 172 patients undergoing subtotal parathyroidectomy; the study was not randomised but rather an intraoperative decision was made by the surgeon based on the size of the parathyroid glands and clinical context.…”

Section: Surgical Considerationsmentioning

confidence: 99%

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

Lawrence,

Johri,

Dave

et al. 2023

Langenbecks Arch Surg

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Background Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. Methods We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. Conclusion Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.

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“…Depending on surgical approach and the specific criteria for gland involvement, which are usually based on size, subsequent investigators have reported rates of multiple-gland disease as low as 0% and as high as 48% [37,99,100]. In general, studies advocating unilateral exploration document a lower incidence of multiple-gland disease [39,94,101] than those that support routine bilateral exploration [7,63,65,79,102].…”

Section: Incidence Of Multiple Gland Diseasementioning

confidence: 99%