Intraoperative parathyroid hormone (PTH) assay (QPTH) has made possible less invasive operative approaches in the treatment of primary hyperparathyroidism with stated advantages. When compared to the traditional bilateral neck exploration (BNE), only the targeted, hypersecreting gland is excised, leaving in situ non-visualized but normally functioning parathyroids. The QPTH-guided limited parathyroidectomy (LPX) must be able to identify multiglandular disease (MGD), predict a successful outcome, and have a low recurrence rate. In our series, 421 patients who underwent LPX were compared to 340 undergoing BNE; all operative failures and patients followed for 6 months or longer were included. Operative failure occurred if serum calcium and PTH levels were elevated within 6 months of parathyroidectomy. Multiglandular disease was defined in the LPX group as more than one gland excision guided by QPTH or operative failure after removal of a single abnormal gland; in the BNE group it was defined as excision of more than one enlarged gland. Recurrence was defined as elevated calcium and PTH after 6 months of eucalcemia. Operative failure and MGD rates were compared using chi-squared analysis. The method of Kaplan-Meier and the log-rank test were used to compare recurrence rates. Operative success was seen in 97% of LPX patients and in 94% of the BNE group (p = 0.02). Multiglandular disease was identified in 3% of LPX patients and 10% of BNE patients (p < 0.001). There was no statistical difference in the overall recurrence rates (p = 0.23). The QPTH-guided parathyroidectomy identifies MGD and allows an improved success rate with the same low recurrence rate when compared to the results of BNE.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
We acknowledge the assistance of Marcela Ramirez, M.D., and Theresa Lee, M.D., and thank them for the data collection and patient follow-up required for the preparation of this manuscript.
Carneiro, DM, Solorzano, CC, Nader, MC, et al. 2003Irvin GL 3rd. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: Which criterion is the most accurate?Surgery134973981CrossRefPubMedGoogle Scholar
Irvin, GL,3rd, Carneiro, DM, Solorzano, CC 2004Progress in the operative management of sporadic primary hyperparathyroidism over 34 yearsAnn. Surg.239704711CrossRefPubMedGoogle Scholar
Nussbaum, SR, Zahradnik, RJ, Lavigne, JR, et al. 1987Highly sensitive two-site immunoradiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemiaClin. Chem.3313641367PubMedGoogle Scholar
Sokoll, LJ, Wians, JFH, Remaley, AT 2004Rapid intraoperative immunoassay of parathyroid hormone and other hormones: a new paradigm for point-of-care testingClin. Chem.5011261135CrossRefPubMedGoogle Scholar
Carneiro, DM, Irvin, GL,3rd2002New point-of-care intraoperative parathyroid hormone assay for intraoperative guidance in parathyroidectomyWorld J. Surg.2610741077CrossRefPubMedGoogle Scholar
Heerden, JA, Grant, CS 1991Surgical treatment of primary hyperparathyroidism: an institutional perspectiveWorld J. Surg.15688692PubMedGoogle Scholar
Rudberg, C, Akerstrom, G, Palmer, M, et al. 1986Late results of operation for primary hyperparathyroidism in 441 patientsSurgery99643651PubMedGoogle Scholar
Duh, QY, Arnaud, CD, Levin, KE, et al. 1986Parathyroid hormone: before and after parathyroidectomySurgery10010211031PubMedGoogle Scholar
Agarwal, G, Barakate, MS, Robinson, B, et al. 2000Intraoperative quick parathyroid hormone versus same-day parathyroid hormone testing for minimally invasive parathyroidectomy: a cost-effectiveness studySurgery130963970CrossRefGoogle Scholar
Gordon, LL, Snyder, WH, Wians, F,Jr, et al. 1999The validity of quick intraoperative hormone assay: an evaluation in seventy-two patients based on gross morphology criteriaSurgery12610301035CrossRefPubMedGoogle Scholar
Milas, M, Wagner, K, Easley, MA, et al. 2003Double adenomas revisited: nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease)Surgery1349951004CrossRefPubMedGoogle Scholar
Miccoli, P, Berti, P, Conte, M, et al. 2000Minimally invasive video-assisted parathyroidectomy: lessons learned from 137 casesJ. Am. Coll. Surg.191613618CrossRefPubMedGoogle Scholar
Sokoll, LJ, Drew, H, Udelsman, R 2000Intraoperative parathyroid hormone analysis: a study of 200 consecutive casesClin. Chem.4616621668PubMedGoogle Scholar
Henry, JF, Misso, C, Sebag, F, et al. 2003Video-assisted minimally invasive parathyroidectomy with lateral approach in patients with primary hyperparathyroidismAnn. Ital. Chir.74401405PubMedGoogle Scholar
Irvin, GL,3rd, Sfakianakis, G, Yeung, L, et al. 1996Ambulatory parathyroidectomy for primary hyperparathyroidismArch. Surg.13110741078PubMedGoogle Scholar
Chen, H, Sokoll, LJ, Udelsman, R 1999Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assaySurgery12610161021CrossRefPubMedGoogle Scholar