Minimally invasive parathyroid surgery (original) (raw)
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Principles of Minimally Invasive Parathyroidectomy
Current Medical Imaging Reviews, 2008
In primary hyperparathyroidism, one or more of the parathyroid glands are either enlarged or hyperactive. While medical management is possible for selected patients, surgical excision remains the only definitive treatment. Recently, improved radiographic techniques have fostered the widespread adoption of minimally invasive parathyroidectomy (MIP). Patients undergoing MIP benefit from improved cosmesis, reduced post-operative pain, a shorter length of stay, and a quicker return to pre-operative activity level. MIP is possible due to accurate pre-and intra-operative sestamibi localization of the overactive parathyroid glands, resulting in a more targeted operation. In this review of radioguided MIP, we detail the indications, operative technique, special situations, and look toward the future.
Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism
Surgical Clinics of North America, 2004
When minimally invasive parathyroidectomy (MIP) was last reviewed in Surgical Clinics of North America only 3 years ago, Howe (1) noted that a striking change had already taken place in the management of primary hyperparathyroidism. The traditional paradigm of bilateral neck explora- tion (BNE) and four-gland evaluation was being replaced with one of unilateral exploration and limited evaluation, based upon
Targeted parathyroid surgery also referred to as minimally invasive parathyroidectomy has replaced full neck exploration as the preferred surgical approach to primary hyperparathyroidism. This is attributed to the ability to accurately localize enlarged parathyroid glands preoperatively and obtain objective evidence of adequate resection intraoperatively. The two most widely used minimally invasive parathyroid surgeries are the non-endoscopic mini-incision parathyroidectomy and the minimally invasive video-assisted parathyroidectomy. The aim of this article is to provide a detailed illustration of the latter supplemented with an animated video of the procedure, and to highlight a potential advantage it offers over other targeted parathyroid procedures; the ability to perform a full neck exploration and/or a concomitant thyroid surgery without the need to convert to a standard cervicotomy.
Minimally Invasive Parathyroidectomy
Archives of Surgery, 2011
Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism can be successfully performed using preoperative sestamibi scan and intraoperative radioguidance without the need of measurement of intraoperative parathyroid hormone (PTH) levels. The purpose of our study was to review the outcomes of MIPs performed in a community hospital without measuring PTH levels intraoperatively and to demonstrate that this is an effective therapeutic modality with comparable success rates. We performed a retrospective medical record review of patients undergoing MIPs from April 1, 1998, through May 31, 2005, in a 500-bed community hospital. A total of 188 parathyroidectomies for primary hyperparathyroidism were performed by a single surgeon during the study period, 111 of which were MIPs. In this series of 111 patients, we found 2 recurrences, achieving a success rate of 98.2%. Higher preoperative PTH levels and gland weight had a direct correlation with the successful performance of MIP.
Langenbecks Archives of Surgery, 2000
The currently established procedure for surgical treatment of primary hyperparathyroidism is bilateral exploration and visualization of all four glands to identify an adenoma and exclude multiglandular disease. With the development of improved preoperative localization imaging of the parathyroids using high-resolution ultrasonography and sestamibi scintigraphy, on the one hand, and perioperative control of surgical success with a rapid parathyroid hormone assay on the other, unilateral and minimally invasive techniques have become feasible. For patients with unequivocal localization in preoperative sestamibi scintigraphy and high-resolution ultrasonography of the parathyroid adenoma in probable single-gland disease, the unilateral and minimally invasive parathyroidectomy present a therapeutic option. Perioperative rapid parathyroid hormone assays, although costly, offer immediate supervision of adenoma extirpation and differentiation of single- and multiglandular disease. These methods demonstrate advantages with favorable cosmetic results and lower reported rate of postoperative hypoparathyroidism. These methods are already being practiced in some places under local anesthesia and in an ambulatory setting. This contribution provides an introduction and overview of the currently practiced unilateral and minimally invasive techniques of parathyroidectomy for primary hyperparathyroidism, discussing indications, advantages and disadvantages, and technical differences in the practiced methods.
Endoscopically assisted, minimally invasive parathyroidectomy
British Journal of Surgery, 1999
Background Despite the success of open parathyroid exploration, minimally invasive alternatives have been emerging. This study reports an experience with endoscopically assisted, minimally invasive parathyroidectomy and evaluates its current role in patients undergoing surgery for hyperparathyroidism. Methods One hundred consecutive patients requiring surgery for hyperparathyroidism were evaluated. Endoscopic parathyroidectomy was offered based on the absence of coexisting nodular thyroid disease, previous neck surgery or irradiation, suspicion of parathyroid hyperplasia, or other anatomical or medical contraindications. Some 24 of 100 patients fulfilled the criteria and underwent endoscopic parathyroidectomy. Unequivocal localization to a single site by a technetium-99m-radiolabelled sestamibi scan allowed removal of the adenoma through a 25-mm suprasternal incision while being guided by a surgical telescope. Results There were no statistically significant differences in operating ...
Minimally invasive endoscopic selective parathyroidectomy
2012
Primary hyperparathyroidism is a common condition with surgery being the definitive treatment modality. Controversy exists over the extent of optimal neck exploration, whether unilateral or bilateral exploration should be performed, particularly since 85-90% of primary hyperparathyroidism results from single gland disease. Unilateral neck exploration is now considered to be adequate unless a definitive adenoma is not identified on ipsilateral exploration and where the serum intact Parathyroid Hormone (iPTH) level does not show a decline greater than 60% after removal of a suspected adenoma. It also avoids the potential risk of hypocalcaemia, recurrent laryngeal nerve injury along with extended anaesthesia and operative time and in-patient stay.
The Surgical Treatment of Primary Hyperparathyroidism
Annals of Surgery, 1977
Objective: To review the surgical treatment options for primary hyperparathyroidism with a focus on recent refinements in minimally invasive techniques and endoscopic and video-or robot-assisted parathyroidectomy. Methods: We review the relevant surgical treatment options for primary hyperparathyroidism. Results: Parathyroidectomy is the standard therapy for patients with primary hyperparathyroidism. Advancements in imaging, including technetium Tc 99m-sestamibi single-photon emission computed tomography and ultrasonography, have improved preoperative localization, while intraoperative parathyroid hormone measurement provides a rapid test to confirm operative success. These adjuncts have enabled surgeons to perform an operation that is both safe and minimally invasive. Conclusions: The minimally invasive approach to parathyroidectomy provides comparable cure rates to conventional bilateral neck exploration with reduced operative time and improved cosmetic results. The durability, safety, and success of these procedures make them valuable options in the current and future care of patients with primary hyperparathyroidism.
Minimally invasive video assisted parathyroidectomy (MIVAP)
European Journal of Surgical Oncology (EJSO), 2003
The first endoscopic approach to parathyroid glands was reported by M. Gagner in 1996. Later, different accesses have been described using either CO 2 insufflation or external retraction. Other widespread procedures include the lateral access proposed by J.F. Henry and the central gas-less access proposed by P. Miccoli. We hereby describe this central access which allows a bilateral exploration of the neck when necessary. Our patient data base consists of 270 patients operated on since February 1997. The mean age was 56.5 years (20±87 years). The female to male ratio was 4 X 1. The mean operative time of the procedure was 41.1 min (range 15±180 min). In 13 cases, a video-associated thyroid resection was accomplished during the same operation for associated diseases. Conversion to traditional cervicotomy was required in 20 patients (8.09%). One laryngeal nerve palsy was confirmed 6 months after surgery. We registered one postoperative bleeding, which required us to reoperate on the patient 2 hours after first surgery. The mean operative time and complication rate clearly demonstrate that this approach, like other minimally invasive techniques, can successfully rival the results of traditional surgery for the treatment of primary hyperparathyroidism.