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Minimally invasive open parathyroidectomy — A review

Minimal-invasive offene Parathyreoidektomie — eine Übersicht

  • Main Topic: Minimally Invasive Endocrine Surgery
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: Although bilateral neck exporation is the standard procedure in biochemically proven primary hyperparathyroidism a unilateral approach was developed to reduce surgical trauma, morbidity and duration of operation. The improvement of preoperative localisation methods and the introduction of a quick parathyroid hormone (QPTH) assay have helped to establish minimally invasive techniques.

Methods: Reviewing literature, the clinical value of minimally invasive open parathyroidectomy (MIP; localized single gland disease, lateral approach through a 15–20 mm incision, selected exstirpation of the parathyroid tumor, documentation of the surgical success using QPTH assay) was analyzed and compared with endoscopic procedures.

Results: Reviewing literature, eight authors describe 436 patients witReviewing literature, eight authors describe 436 patients with MIP. MIP was successfully performed in 401 out of 436 patients (92 %). A conversion to standard bilateral exploration was performed in 29 patients. Causes for conversion were false positive localisation in 12 (41 %), multiple gland disease in seven (24 %), double adenoma in four (14 %), difficult dissection in four (14%), concomitant thyroid disease in one and scars during reoperation in another. Complications are documented in three patients (0.7 %; paralysis of recurrent laryngeal nerve: two; rupture of a cystic parathyroid adenoma: one).

Conclusions: Because of good functioning and excellent cosmetic results MIP is a cost-effective alternative to endoscopic procedures in localised single gland disease. Using a paramedian miniincision, the recurrent laryngeal nerve can be visualized and concomitant ipsilateral thyroid pathology can be treated. MIP is also feasible in reoperations. Intraoperative QPTH assay is mandatory.

Zusammenfassung

Grundlagen: Obwohl die bilaterale cervikale Exploration als Standardeingriff beim biochemisch gesicherten primären Hyperparathyreoidismus (PHPT) gilt, wurden einseitige Halsfreilegungen entwickelt, um operatives Trauma, Morbidität und Operationszeit zu verringern. Durch Verbesserung präoperativer Lokalisationsmethoden und Entwicklung einer intraoperativen Parathormon-Überwachung (QPTH) wurden minimal invasive Verfahren etabliert.

Methodik: Anhand einer Literaturübersicht wird der Stellenwert der minimal invasiven offenen Parathyreoidektomie (MIP; Lokalisation der Eindrüsenerkrankung durch 99Tc Sestamibi und Ultraschall, laterale Freilegung durch eine 15 bis 20 mm lange Inzision, Exstirpation des Parathyreoideatumors, Bestätigung des chirurgischen Erfolgs mittels QPTH Assay) untersucht und im Vergleich mit endoskopischen Verfahren evaluiert.

Ergebnisse: Bei Durchsicht der Literatur beschreiben 8 Autoren 436 Patienten mit MIP. Bei 401 Patienten (92 %) war die MIP erfolgreich. Eine Konversion zur beidseitigen Halsexploration wurde bei 29 Patienten durchgeführt. Gründe für die Konversion waren eine falsch positive Lokalisation bei 12 Patienten (41 %), eine Mehrdrüsenerkrankung bei 7 Patienten (7 %), ein Doppeladenom bei 4 Patienten (14 %), eine schwierige Freilegung bei 4 Patienten (14 %) sowie eine zusätzliche Schilddrüsenerkrankung und Narben im Rahmen einer Reoperation bei je einem Patienten. Komplikationen traten bei 3 Patienten (0,7 %; Recurrensparese: 2; Ruptur eines cystischen Parathyreoideaadenoms: 1) auf.

Schlußfolgerungen: MIP ist bei lokalisierter Eindrüsenerkrankung aufgrund des guten funktionellen und des ausgezeichneten kosmetischen Ergebnisses durch paramediane Miniincision, übersichtliche Freilegung des N. laryngeus recurrens, sowie der Möglichkeit einer gleichzeitigen ipsilateralen Schiddrüsenresektion eine echte, kostengünstige Alternative zu endoskopischen Verfahren. MIP ist auch bei Reeingriffen einsetzbar. Der chirurgische Erfolg muß mit dem intraoperativen QPTH-Assay bestätigt werden.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University Vienna, Medical School, Währinger Gürtel 18-20, A-1090, Vienna

    G. Prager, Ch. Passler, Ch. Scheuba & Bruno Niederle M.D.

  2. Department of Surgery, Division of Endocrine and Oncologic Surgery, the John Hopkins Medical Institutions, Baltimore, U.S.A.

    R. Udelsman

  3. Department of Clinical Physiopathology, Section of General Surgery, University of Turin, Italy

    G. Gasparri

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  1. G. Prager
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  2. Ch. Passler
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  3. Ch. Scheuba
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  6. Bruno Niederle M.D.
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Correspondence to Bruno Niederle M.D..

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Prager, G., Passler, C., Scheuba, C. et al. Minimally invasive open parathyroidectomy — A review. Acta Chir Austriaca 31, 221–226 (1999). https://doi.org/10.1007/BF02620168

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