Abstract
Efforts to minimize the incision, extent of exploration, length of hospital stay, and cost associated with parathyroidectomy have resulted in the development of a number of new surgical techniques, including minimally invasive, "concise," radio-guided, and endoscopic parathyroid exploration. With minimally invasive parathyroidectomy, a small incision is used in combination with a cervical block and sedation to perform a unilateral neck exploration. In so doing, risks of bilateral neck exploration are avoided, and the procedure can be done on an outpatient basis. This minimally invasive strategy has been shown to maintain the outstanding success of conventional bilateral neck exploration. All of the new surgical techniques necessitate pre-operative localization, which allows for unilateral neck exploration, and are facilitated by use of the intra-operative parathyroid hormone assay, which provides surgeons with feedback in the operating room regarding whether the patient has undergone adequate resection.
Highlights
Primary hyperparathyroidism is a common endocrine disease caused by a single parathyroid adenoma in 85% of patients
A number of new minimally invasive techniques have been developed including open minimally invasive parathyroidectomy (MIP) which we describe in this paper
In a prospectively collected and retrospectively reviewed series of 656 consecutive parathyroidectomies performed between 1990 and 2001, we reported no significant difference in complication rates (3% and 1.2%, resp.) or cure rates (97% and 99%, resp.) [43]
Summary
Primary hyperparathyroidism (pHPT) is a common endocrine disease caused by a single parathyroid adenoma in 85% of patients. A large number of studies have been published over the last decade describing various techniques in minimally invasive parathyroidectomies, and comparing outcomes to each other and to that of conventional bilateral exploration. The indications for MIP are identical to those for traditional bilateral neck exploration, including patients with symptomatic disease and those with asymptomatic pHPT in accordance with recently published guidelines [7]. In addition to those patients with overt symptoms and signs, there is a large number of patients with significant neurocognitive derangements with biochemically proven pHPT that could potentially benefit from resection [8,9,10]. In the majority of these patients, conventional bilateral exploration is recommended due to the frequency of multiglandular disease [11]
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