ES12 CAN GIANT PARATHYROID ADENOMAS BE SAFELY REMOVED BY MINIMALLY INVASIVE PARATHYROIDECTOMY?

Abstract

Purpose Minimally invasive parathyroidectomy (MIP) has become the procedure of choice for the surgical management of a parathyroid adenoma (PA) which localizes on preoperative imaging. The removal of giant PA (weighing greater than two grams) by the minimally invasive technique has not previously been described. Our aim was to determine the safety and efficacy of the removal of giant parathyroid adenomas at MIP.Methodology This is a retrospective case control study. The study group comprise all patients undergoing MIP where the gland weight was >2.0 gm in the period 1998 to 2006. The control group comprised all other patients undergoing MIP (gland weight <2.0 gm over the same period.) MIP was performed using the lateral mini‐incision technique.Results There were 52 giant PA (M : F – 16 : 36, mean age 61.9) comprising 3% of all cases, and 785 control patients (M : F – 160 : 625, mean age 58.9). The mean weight of the giant PA was 3.64 gm (range 2.0 to 10.8 gm). The giant PA were successfully removed in 49/52 cases with 3 conversions (5.7%), whereas there were 40/785 conversions (5.0%) in the control group (p = 0.83). There was 1/52 (1.9%) permanent recurrent laryngeal nerve injury in the study group and 2/785 (0.3%) nerve palsies in the control group (p = 0.51). One patient (1.9%) in the giant PA group had persistent hyperparathyroidism, whereas there were 21 (2.7%) patients in the small adenoma group requiring re‐exploration for persistent hyperparathyroidism. There were 2/52 (3.8%) carcinomas in the giant PA group compared to 2/785 (0.25%) in the control group.Conclusion Excision of giant PA using a minimally invasive technique can be performed with the same safety, efficacy and outcomes as for smaller adenomas.