Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution.

Abstract

Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision. In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n=190) undergoing a standard immediate autotransplantation. We divided patients in two main groups: group A (n=160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n=236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P<0.001): 91.9% were transient and 8.1% (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P=0.616 vs. group A and P=0.002 vs. group B) and 3/42 became definitive (P=0.096 vs. group A and P=0.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P<0.001). We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation.