Surgical and calcium outcomes in 427 patients treated prospectively in an image‐guided and intraoperative PTH (IOPTH) supplemented protocol for primary hyperparathyroidism: Outcomes and opportunities

Bumpous, Jeffrey M.; Goldstein, Richard; Flynn, Michael B.

doi:10.1002/lary.20049

Cited by 12 publications

(13 citation statements)

References 23 publications

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“…The cure rates for a MIP that incorporated both preoperative imaging and intraoperative PTH assessment were as good as or better than the mean published rates for planned BNE with four‐gland dissection (Table ; Fig. ) …”

Section: Resultsmentioning

confidence: 78%

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Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Walsh

Sullivan

Duke

et al. 2018

Laryngoscope Investig Oto

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Objective Recent advances in preoperative imaging techniques and intraoperative parathyroid hormone (ioPTH) assays have made single‐gland, minimally invasive parathyroidectomy (MIP) the preferred treatment option for most patients with primary hyperparathyroidism (pHPT). Despite this evolution, a recommendation for bilateral neck exploration (BNE) with four‐gland dissection in all patients has recently been advocated by a parathyroid surgical group. The current study compares the long‐term outcomes of MIP with those of conventional BNE with four‐gland dissection in patients with pHPT. Methods In order to objectively assess a recommendation in the literature that universal BNE with four‐gland dissection is advisable, all patients undergoing an initial MIP with ioPTH assessment for pHPT in a tertiary endocrine practice during a 10‐year period were reviewed. The cure rates from this procedure were compared with published results of conventional BNE with four‐gland dissection. Results Of the 561 patients undergoing parathyroidectomy during the study period, 337 had initial surgery for pHPT; 282 of these patients met inclusion criteria and 212 had sufficient follow‐up data available. A single adenoma was identified in 87.3% of cases. Preoperative imaging studies were co‐localizing in 148 (69.8%), and 127 (85.8%) of these patients with co‐localizing imaging required only single‐gland surgery. Imaging studies did not co‐localize in 49 patients, yet 32 (65.3%) of these patients were still cured with unilateral surgery. The cure rate for patients undergoing MIP was 98.6%, with a long‐term recurrence rate of <2%. Conclusion When coupled with the ioPTH assay, patients with at least one preoperative localizing study can undergo MIP and anticipate a cure rate of 99%, which is as good as or better than the published rates for conventional BNE with four‐gland dissection. With unilateral surgery, the risks of permanent hypoparathyroidism and airway obstruction from bilateral vocal fold paralysis are completely eliminated. Therefore, despite recommendations to the contrary, most patients with pHPT should not have a planned four‐gland exploration. Level of Evidence III or IV

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Section: Resultsmentioning

confidence: 78%

“…1). 14,[18][19][20][21][22][23][24][25][26][27] The ioPTH was an important confirmatory adjunct in the successful operations (209 of 212). Additionally, in the three patients with persistent disease in which no adenoma was found the ioPTH assay accurately confirmed intraoperatively that the exploration was not successful.…”

Section: Resultsmentioning

confidence: 99%

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Walsh

Sullivan

Duke

et al. 2018

Laryngoscope Investig Oto

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show abstract

“…Reduction of length of surgery, anesthesia, and hospital stay; avoiding intraoperative histologic analysis; and/or IOPTH have resulted in considerable financial benefit of minimally invasive procedures compared with the other operative options. 9,26,40 There are no conclusive data indicating that MIRP can be performed more quickly and with less dissection than MIP.…”

Section: Image-guided Parathyroidectomymentioning

confidence: 99%

“…One of the debates arising from the widespread practice of image-guided parathyroidectomy is the value of this technology intraoperatively. 40,41 Specifically, whether the use of the gamma probe during image-guided parathyroidectomy adds to the outcome compared with minimally invasive approach without the gamma probe.…”

mentioning

confidence: 99%

Article Commentary: Current Status of Surgical Techniques for Parathyroidectomy for Untreated Primary Hyperparathyroidism: Is the Technology Worth It?

Flynn

Civelek

2010

The American Surgeon™

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“…: Outcomes of Focused Radio-Guided Parathyroidectomy and Bilateral Explorations Zachary J. Cappello, BS; Jeffrey M. Bumpous, MD BACKGROUND Primary hyperparathyroidism (HPT) is a relatively common surgical disease caused principally by singlegland enlargement and hyperfunction. 1 In experienced hands, 95% of patients are rendered normocalcemic after parathyroidectomy, with minimal morbidity. Traditionally, a bilateral neck exploration (BNE) is the technique of choice.…”

mentioning

confidence: 99%

Is bilateral exploration still the standard of care for primary hyperparathyroidism?: Outcomes of focused radio‐guided parathyroidectomy and bilateral explorations

Cappello

Bumpous

2013

The Laryngoscope

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Surgical and calcium outcomes in 427 patients treated prospectively in an image‐guided and intraoperative PTH (IOPTH) supplemented protocol for primary hyperparathyroidism: Outcomes and opportunities

Cited by 12 publications

References 23 publications

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Article Commentary: Current Status of Surgical Techniques for Parathyroidectomy for Untreated Primary Hyperparathyroidism: Is the Technology Worth It?

Is bilateral exploration still the standard of care for primary hyperparathyroidism?: Outcomes of focused radio‐guided parathyroidectomy and bilateral explorations

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