Abstract
The surgical management of parathyroid disorders has been changing rapidly over the last two decades. Though there are still occasions to utilize the traditional bilateral four-gland exploration, this approach has largely given way to more focused, minimally invasive procedures. This shift has been driven by advancements in medical technology and the surgeon’s ability to use these new tools to more accurately diagnose the extent of the disease, the location of the offending parathyroid glands, and the biochemical completeness of the resection. This chapter reviews the evaluation of primary hyperparathyroidism and details the minimally invasive, non-endoscopic approach to the operative management of this disease.
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Berber E, Parikh R, Ballem N, et al. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery. 2008;144(1):74–9.
Bilezikian J, Potts J, Fuleihan G, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87(12):5353–61.
Bilezikian J, Khan A, Potts J. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94(2):335–9.
Chazen J, Gupta A, Dunning A, Phillips C. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. Am J Neuroradiol. 2012;33:429–33.
Cheung K, Wang T, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19:577–83.
Cho N, Gawande A, Sheu E, et al. Critical role of identification of the second gland during unilateral parathyroid surgery: a prospective review of 119 patients with concordant localization. Arch Surg. 2011;146(5):512516.
Christensen S, Nissen P, et al. Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcemia and primary hyperparathyroidism: a follow-up study on methods. Clin Endocrinol. 2008;69:713–20.
Crea N, Pata G, Casella C, et al. Predictive factors for postoperative severe hypocalcaemia after parathyroidectomy for primary hyperparathyroidism. Am Surg. 2012;78(3):352–8.
Denham D, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg. 1998;186(3):293–304; discussion 304–5.
Eastell R, Arnold A, Brandi M, et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):340–50.
Erbil Y, Barbaros U, Tukenmez M, et al. Impact of adenoma weight and ectopic location of parathyroid adenoma on localization study results. World J Surg. 2008;32:566–71.
Fancy T, Gallagher D, Hornig J. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin N Am. 2010;43:221–7.
Gracie D, Hussain S. Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review. J Laryngol Otol. 2012;126:221–7.
Grayev A, Gentry L, Hartman M, et al. Presurgical localization of parathyroid adenomas with magnetic resonance imaging at 3.0 T: an adjunct method to supplement traditional imaging. Ann Surg Oncol. 2012;19:981–9.
Heizmann O, Viehl C, Schmid R, et al. Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism. Eur J Med Res. 2009;14:37–41.
Heller K, Blumberg S. Relation of final intraoperative parathyroid hormone level and outcome following parathyroidectomy. Arch Otolaryngol Head Neck Surg. 2009;135(11):1103–7.
Hunter J. Minimally invasive surgery: the next frontier. World J Surg. 1999;23:422–4.
Kamaya A, Quon A, Jeffrey R. Sonography of the abnormal parathyroid gland. Ultrasound Q. 2006;22(4):253–62.
Kandil E, Malazai A, Alrasheedi S, Tufano R. Minimally invasive/focused parathyroidectomy in patients with negative sestamibi scan results. Arch Otolaryngol Head Neck Surg. 2012;138(3):223–5.
Kebebew E, Hwang J, Reiff E, et al. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006;141:777–82; discussion 782.
Keutgen X, Buitrago D, Filicori F, et al. Calcimimetics versus parathyroidectomy for treatment of primary hyperparathyroidism: retrospective chart analysis of a prospective database. Ann Surg. 2012;255(5):981–5.
Khan A, Grey A, Shobak D. Medical management of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):373–81.
Miccoli P, Materazzi G, Bonari G, et al. Minimally invasive video-assisted parathyroidectomy. Oper Tech Otolaryngol. 2008;19:22–5.
Moore F. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg. 1994;178:11–6.
Moreno M, Callender G, Woodburn K, et al. Common locations of parathyroid adenomas. Ann Surg Oncol. 2011;18:1047–51.
Nagar S, Reid D, Czako P, et al. Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism. Am J Surg. 2012;203(2):177–81.
Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg. 1998;64(5):391–5.
Pellitteri P. Intraoperative assessment of parathyroid hormone. Oper Tech Otolaryngol. 2009;20:60–5.
Phillips C, Shatzkes D. Imaging of the parathyroid glands. Semin Ultrasound CT MR. 2012;33:123–9.
Prager G, Czerny C, Kurtaran A. Minimally invasive open parathyroidectomy in an endemic goiter area. Arch Surg. 2001;136:810–6.
Prager G, Czerny C, Ofluoglu S, et al. Impact of localization studies on feasibility of minimally invasive parathyroidectomy in an endemic goiter region. J Am Coll Surg. 2003;196(4):541–8.
Richards M, Thompson G, Farley D, Grant C. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg. 2011;146(3):280–5.
Ritter H, Milas M. Bilateral parathyroid exploration for hyperparathyroidism. Oper Tech Otolaryngol. 2009;20:44–53.
Ruda J, Hollenbeak C, Stack B. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132:359–72.
Sharma J, Mazzaglia P, Milas M, et al. Radionuclide imaging for hyperparathyroidism (HPT): which is best technetium-99m sestamibi modality. Surgery. 2006;140(6):856–63; discussion 863–5.
Shindo M, Rosenthal J. Minimal access parathyroidectomy using the focused lateral approach: technique, indication and results. Arch Otolaryngol Head Neck Surg. 2007;133(12):1227–34.
Silverberg S, Lewiecki M, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):351–65.
Siperstein A, Berber E, Mackey R, et al. Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery. 2004;136(4):872–8; discussion 878–80.
Smith N, Magnuson J, Vidrine D, et al. Minimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies. Arch Otolaryngol Head Neck Surg. 2009;135(11):1108–11.
Stack B. Minimally invasive radioguided parathyroidectomy. Oper Tech Otolaryngol. 2009;20:54–9.
Starker L, Fonseca A, Carling T, Udelsman R. Minimally invasive parathyroidectomy. Int J Endocrinol. 2001;206502:1–8. Published Online 2011 May 23.
Suliburk J, Perrier N. Primary hyperparathyroidism. Oncologist. 2007;12:644–53.
Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235(5):665–72.
Udelsman R. Approach to the patient with persistent or recurrent primary hyperparathyroidism. J Clin Endocrinol Metab. 2011;96(10):2950–8.
Udelsman R, Carling C. Focused approach to parathyroidectomy. World J Surg. 2008;32:1512–7.
Udelsman R, Pasieka J, Sturgeon C, Clark O. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):366–72.
Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253(3):585–91.
Van Husen R, Kim L. Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg. 2004;28:1122–6.
Vasher M, Goodman A, Politz D, Norman J. Postoperative calcium requirements in 6,000 patients undergoing outpatient parathyroidectomy: easily avoiding symptomatic hypocalcemia. J Am Coll Surg. 2012;211(1):49–54.
Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five year follow-up of a randomized controlled trial. Ann Surg. 2007;246(6):976–80; discussion 980–1.
Zanocco K, Angelos P, Sturgeon C. Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery. 2006;140(6):874–81; discussion 881–2.
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Duke, W.S., Terris, D.J. (2014). Minimally Invasive Non-endoscopic Parathyroidectomy. In: Terris, D., Singer, M. (eds) Minimally Invasive and Robotic Thyroid and Parathyroid Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9011-1_16
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DOI: https://doi.org/10.1007/978-1-4614-9011-1_16
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