Radio-guided minimally invasive parathyroidectomy under local anesthesia

Abstract

Despite the high success rate of the complete bilateral neck exploration to treat primary hyperparathyroidism, less invasive alternatives have been emerging. In an attempt to reduce operative time and decrease perioperative morbidity, we reported our experience with radio-guided minimally invasive parathyroidectomy (RMIP) under local anesthesia. A retrospective chart review was carried out to study 55 consecutive patients, in an adult tertiary care hospital (Montreal General Hospital), who underwent RMIP under local anesthesia over a 30-month period. Charts were reviewed for operative information, radiological and pathological diagnoses and post-operative course. The main outcome measures were the accuracy of localizing the parathyroid adenoma, operative time, achievement of normocalcemia post-operatively and perioperative morbidity. Of the 55 patients we studied, 51 were cured as defined by normocalcemia following a single intervention, for an overall cure rate of approximately 93%. Four patients required an additional procedure: In two because of failure to remove a diseased gland, and in two because of multiglandular disease. The preoperative sestamibi scan accurately predicted the location of all abnormal parathyroid glands in 53 cases. In the remaining two cases, the scan failed to predict multiglandular disease. Average total operative time was 39 minutes. There were no major complications. RMIP under local anesthesia is a safe and effective modality to treat primary hyperparathyroidism. The short operative time, the use of local anesthesia and the low complication rate make this technique a viable alternative.