Conventional parathyroidectomy versus noninstrumental minimally invasive parathyroidectomy in parathyroid adenoma (original) (raw)

Abstract

Parathyroid glands are usually found with intrathyroidal involvement behind the thyroid glands and are responsible for parathyroid hormone (PTH) secretion. Rarely, they can also be localized as extrathyroidal with thyroid agenesis [1]. Primary hyperparathyroidism (PHPT) is a common endocrine system disease characterized by the excessive release of PTH. PHPT is the third most common endocrine disorder in the United States with an annual incidence of 100,000 [2]; 1 out of every 500 women and 1 out of every 2000 men are affected by this disease annually [3]. A quick review of the literature shows that around 80% of PHPT cases are single parathyroid adenoma (SA), 15% are parathyroid hyperplasia, 5% are multiple parathyroid adenoma, and 1% are parathyroid cancer [4]. PHPT is usually asymptomatic. Symptomatic PHPT has various symptoms of hypercalcemia, such as fatigue, nausea, loss of appetite, peptic ulcer disease, diarrhea, changes in mental state, recurrent kidney stones, and bone disease or bone loss [5]. The conventional method of choice for parathyroidectomy is bilateral neck exploration (BNE). In BNE, bilateral exploration is performed, and gland/glands thought to be pathological are excised. BNE was considered the gold standard surgery; after the introduction of parathyroid scintigraphy (PS), unilateral neck exploration and selective parathyroidectomy (SP) started to gain popularity. SP can be performed as open, minimally invasive parathyroidectomy (MIP), endoscopic, radio-guided, or video-assisted [6].

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