A single surgical experience with 493 directed explorations for hyperparathyroidism

Abstract

Objectives: To understand and implement an effective minimally invasive surgical protocol in patients with primary hyperparathyroidism utilizing appropriate selection criteria. Methods: A retrospective review of the case report forms of 535 patients with hyperparathyroidism surgically managed at an academic tertiary care medical center between December 1996 and December 2003. Case report forms included data on pre- and postoperative biochemical profile; clinical findings; imaging results; surgical findings; pathologic findings, facility utilization; complications; and outcomes. Results: A directed exploration protocol was implemented in 493 of 535 patients surgically managed for hyperparathyroidism (HPT); 55% of patients were asymptomatic or without end organ effect at presentation. The etiology of HPT was primary in 466 patients and secondary/tertiary in 27. Single gland disease was the pathologic entity in 412 patients (3 with carcinoma), followed by diffuse hyperplasia (39) and double adenoma (15). Sestamibi scan accuracy in correctly localizing hyperfunctional parathyroid tissue was 93%. Mean IOPTH degradation was 78% (range, 59%97%). Sustained normocalcemia was achieved in 98.7% of patients following DEP. Mean follow-up interval was 28 months (range, 6–72 m), with a 6-month follow-up for all patients. Eighty-five percent of DEP operative procedures were less than 1 hour and over 90% of patients were managed in an ambulatory care setting. Conclusions: The directed exploration protocol used in this series represents a highly effective and cost-efficient approach in the surgical management of the majority of patients with hyperparathyroidism.