Pedicled Parathyroid Autotransposition in Surgical Management of Secondary Hyperparathyroidism

Abstract

Objectives: In this study, we report a new, less invasive surgical technique in managing preserved parathyroid tissue in patients with secondary hyperparathyroidism who undergo bilateral parathyroid exploration and excision of all 4 parathyroid glands. We report this technique in 4 patients and evaluate their postoperative parathyroid hormone (PTH) levels as a marker to evaluate efficacy. Methods: All 4 glands were first exposed. Superior glands are not possible to transpose and were excised while the inferior glands were mobilized on their pedicles. Once identified, the inferior glands were kept intact until it was determined which gland can be best preserved on its vascular pedicle with adequate length for transposition. This gland was then mobilized through an incision made in the strap muscles, placing it superficial and ventral to the muscles. The majority of the hyperplastic gland was then resected distal to its vascular pedicle. The portion of the gland that was preserved was secured over the strap muscle, making it easily accessible for future exploration and debulking if needed and avoiding a second operative site in the forearm. Results: Rapid intraoperative PTH assay confirmed adequate removal of hypersecreting parathyroids and was indicative of a curative outcome. All patients exhibited a greater than 90% initial reduction in the PTH level from their baseline and a sustained decrease in postoperative PTH levels well below their preoperative baselines at one month. The percentage mean reduction in PTH at longest follow-up was 94.57%. Importantly, none of the patients exhibited postoperative PTH levels indicative of hypoparathyroidism. Conclusions: None provided.