Minimally Invasive Directed Parathyroidectomy Is Effective

Abstract

Objective: 1) To evaluate the outcome of minimally invasive targeted parathyroidectomy (TP) in managing primary hyperparathyroidism. 2) To report on the predictive value of preoperative imaging in success of targeted parathyroid exploration. Method: Prospective noncontrolled cohort study of 208 patients with primary hyperparathyroidism managed in a single academic institution from 2002 to 2011. Patients underwent targeted parathyroidectomy based on preoperative parathyroid sestamibi scan and sonography. Intraoperative rPTH assay was used to determine success and extent of exploration. Follow-up serum calcium levels were obtained. Results: Of the 208 patients with primary hyperparathyroidism, data were available for 202. One hundred seventy-seven underwent targeted parathyroidectomy (89%), 25 underwent bilateral exploration (11%). Of the 202 patients, follow-up calcium data were available for 170 (162 targeted, 8 bilateral explorations). There was a total of 4 out of 170 (2%) recurrences or failed explorations. Of the 4 recurrences, 2 were in targeted and 2 in the bilateral exploration group. Targeted parathyroidectomy was successful in 159 out of 161 (99%) for first-time explorations. Following negative or false-positive imaging, bilateral exploration carried a failure rate of 25% (2/8). Conclusion: Targeted parathyroidectomy following preoperative localization studies with parathyroid sestamibi scan and sonography is highly effective for primary hyperparathyroidism with a success rate of 99%. Among patients with negative or false positive imaging, bilateral exploration carries a failure rate of 25%.