Abstract
Abstract Background Minimally-invasive parathyroidectomy (MIP) techniques have made the procedure safer and more feasible as an outpatient parathyroidectomy (OP). We hypothesized that any type of parathyroidectomy is safe as an outpatient procedure and strive to characterize factors responsible for successful OP. Methods A retrospective analysis was performed of all parathyroidectomies between August 2009 and October 2016 with or without thyroidectomy to identify the type of parathyroid surgery, inpatient parathyroidectomy (IP) vs. OP status, postoperative complications, and resulting clinical outcomes. Results There were 672 parathyroidectomies, 51 IP (7.6%) and 621 OP (92.4%), consisting of 456 focused parathyroidectomies consisting of 1-2 gland resections (P) (67.9%), 68 subtotal parathyroidectomies consisting of 3-3.5 gland resections (SP) (10.1%), 125 P with thyroidectomy (PT) (18.6%), and 23 SP with thyroidectomy (SPT) (3.4%). Anesthesia included 369 (54.9%) under general (GA) and 294 (43.8%) under local anesthesia with monitored anesthesia care (L/MAC). IP experienced more symptomatic hypocalcemia than OP (13.7% vs. 4.3%) (p = 0.01). Symptomatic hypocalcemia was more common after SP (16.2%) or SPT (17.4%) than P (2.2%) or PT (7.2%) (p < 0.0001) and with GA (8.1%) than L/MAC (1.0%) (p < 0.0001). OP had a lower American Society of Anesthesia (ASA) score (2.5 mean) than IP (3.2 mean) (p < 0.0001). Three (5.9%) recurrent laryngeal nerve (RLN) injuries occurred with IP and six (1.0%) with OP (p = 0.02) with only one permanent OP injury (0.16%). RLN injury had no significant association with the extent of surgery (P, SP, PT, and SPT), age, sex or type of anesthesia. One OP postoperative hematoma occurred (0.16%) with a PT. There were no mortalities. Average OP postoperative time to discharge was 2.2 hours. Conclusion Outpatient parathyroid surgery is safe and should be applicable to nearly all patients, except those needing more extensive parathyroidectomy/thyroidectomy surgery or patients with greater comorbidities.
Highlights
Minimally-invasive parathyroidectomy (MIP) techniques have generally reduced the extent of parathyroidectomy surgery necessary to correct hyperparathyroidism
There were 672 parathyroidectomies, 51 inpatient parathyroidectomy (IP) (7.6%) and 621 outpatient parathyroidectomy (OP) (92.4%), consisting of 456 focused parathyroidectomies consisting of 1-2 gland resections (P) (67.9%), 68 subtotal parathyroidectomies consisting of 3-3.5 gland resections (SP) (10.1%), 125 P with thyroidectomy (PT) (18.6%), and 23 SP with thyroidectomy (SPT) (3.4%)
Symptomatic hypocalcemia was more common after SP (16.2%) or SPT (17.4%) than P (2.2%) or PT (7.2%) (p < 0.0001) and with general anesthesia (GA) (8.1%) than local anesthesia with monitored anesthesia care (L/ MAC) (1.0%) (p < 0.0001)
Summary
Minimally-invasive parathyroidectomy (MIP) techniques have generally reduced the extent of parathyroidectomy surgery necessary to correct hyperparathyroidism. These techniques include a much smaller incision (1-2 cm) with exploration that is focused to the side of concern [1]. Better image localization of abnormal parathyroid glands with preoperative ultrasound, parathyroid sestamibi scans, or 4D computerized tomography (CT) have allowed for a focused parathyroid gland exploration and less extensive surgery. This surgical approach can be facilitated with gamma probe localization after the injection of preoperative technetium sestamibi and/or intraoperative parathyroid hormone (PTH) monitoring.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
