Operative Approach to Primary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck
Keyword(s):  
Minimally Invasive ◽  
Laryngeal Nerve ◽  
Minimally Invasive Parathyroidectomy ◽  
Total Parathyroidectomy ◽  
Pharyngeal Pouch ◽  
Subtotal Parathyroidectomy ◽  
Invasive Parathyroidectomy ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone ◽  
Intraoperative Adjuncts

We review the key components of the embryology and anatomy of the parathyroid glands. Here, minimally invasive parathyroidectomy with intraoperative adjuncts such as intraoperative parathyroid hormone monitoring, four-gland exploration, subtotal parathyroidectomy, total parathyroidectomy with autotransplantation, and cyropreservation are described. The incidence of postoperative complications and the technical aspects of parathyroid surgery are delineated. This review contains 3 figures, 1 tables, and 17 references. Key Words: cryopreservation, hyperparathyroidism, minimally invasive parathyroidectomy parathyroidectomy, pharyngeal pouch, recurrent laryngeal nerve, subtotal parathyroidectomy, total parathyroidectomy

Operative Approach to Primary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck
Keyword(s):  
Minimally Invasive ◽  
Laryngeal Nerve ◽  
Minimally Invasive Parathyroidectomy ◽  
Total Parathyroidectomy ◽  
Pharyngeal Pouch ◽  
Subtotal Parathyroidectomy ◽  
Invasive Parathyroidectomy ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone ◽  
Intraoperative Adjuncts

We review the key components of the embryology and anatomy of the parathyroid glands. Here, minimally invasive parathyroidectomy with intraoperative adjuncts such as intraoperative parathyroid hormone monitoring, four-gland exploration, subtotal parathyroidectomy, total parathyroidectomy with autotransplantation, and cyropreservation are described. The incidence of postoperative complications and the technical aspects of parathyroid surgery are delineated. This review contains 3 figures, 1 tables, and 17 references. Key Words: cryopreservation, hyperparathyroidism, minimally invasive parathyroidectomy parathyroidectomy, pharyngeal pouch, recurrent laryngeal nerve, subtotal parathyroidectomy, total parathyroidectomy

scholarly journals The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery

2016 ◽  
Vol 98 (7) ◽  
pp. 516-519 ◽  
Author(s):  
J Helbrow ◽  
AE Owais ◽  
AG Sidwell ◽  
LM Frank ◽  
ME Lucarotti
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Operating Time ◽  
Minimally Invasive Parathyroidectomy ◽  
Parathyroid Surgery ◽  
First Line ◽  
Invasive Parathyroidectomy ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Surgery is the first-line management option for patients with primary hyperparathyroidism (pHPT). Minimally invasive parathyroidectomy (MIP) is now preferable but few centres offer this service, mainly because of lack of intraoperative parathyroid hormone (IOPTH) testing. The aim of this study was to identify whether the measurement of IOPTH in patients having minimally invasive parathyroidectomy for pHPT alters their management. Methods A retrospective review was carried out of 78 consecutive patients who underwent parathyroid surgery by a single surgeon with a special interest in parathyroid surgery. The clinical impact of IOPTH monitoring was recorded postoperatively in a timely manner. Serum adjusted calcium levels were checked preoperatively (on admission) and one month postoperatively; normalisation was considered a cure. Results In the setting of curative MIP, IOPTH measurement did not influence the management in any of the patients but it could have led to bilateral parathyroid exploration (BPE) in three instances. Similarly, in cases that required lengthening of the MIP incision, IOPTH results did not influence patient management although it could have led to BPE in one case. Conclusion MIP offers an effective cure for patients with hyperparathyroidism. The addition of IOPTH testing adds increased expense, operating time and risk to patients otherwise suitable for MIP.

Use of a Sestamibi-only Approach to Routine Minimally Invasive Parathyroidectomy

2013 ◽  
Vol 79 (8) ◽  
pp. 797-801 ◽  
Author(s):  
Adwoa Opoku-Boateng ◽  
John S. Bolton ◽  
Ralph Corsetti ◽  
R. E. Brown ◽  
Chris Oxner ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Parathyroidectomy ◽  
Invasive Parathyroidectomy ◽  
Additional Surgery ◽  
Parathyroid Hormone Monitoring ◽  
Sestamibi Scan ◽  
Surgical Failure ◽  
Intraoperative Parathyroid Hormone ◽  
Extensive Surgery ◽  
Laryngeal Nerve Injuries

We performed this study to compare a sestamibi-only radio-guided approach (MIBI) versus using intraoperative parathyroid hormone monitoring (IOPTH) in the performance of minimally invasive parathyroidectomy (MIP) in patients with a clearly positive preoperative sestamibi scan from January 2000 to June 2010. Five of 81 patients in the MIBI group required additional surgery, three at the time of MIP when the intraoperative findings were in conflict with the preoperative sestamibi scan and two required a second operation as a result of an undiscovered second adenoma. In the IOPTH group, five patients had an unnecessary bilateral neck exploration as a result of an inadequate drop in PTH levels, whereas six had their disease cured because the PTH levels predicted additional pathology. One patient in the IOPTH group remains hypercalcemic and represents the only surgical failure in this study. The MIBI group had a shortened operating room time and less cost ( P < 0.001). No deaths or complications, including recurrent laryngeal nerve injuries, occurred in this study. Although both strategies are effective in managing hyperparathyroidism, a MIBI-only approach is less expensive and has shorter operative times with an occasional need for reoperation, whereas the IOPTH group results in more extensive surgery that will occasionally be unnecessary.

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