Advertisement

Focused Parathyroid Surgery: Minimally Invasive Parathyroidectomy via a Mini-incision

  • Orhan Yalçın
  • Semra Günay
Chapter

Abstract

The most common cause of hypercalcemia is primary hyperparathyroidism (PHPT). Solitary adenoma is detected in 85% of cases, and it is possible to treat these cases with minimally invasive parathyroidectomy (MIP).

We present a 53-year-old female patient of PHPT diagnosed with asymptomatic hypercalcemia and single adenoma, who underwent open-focused MIP via a mini-incision.

In the event of a single adenomatous lesion, diagnosis is possible with the ultrasonography and Tc-99m-sestamibi scintigraphy. If necessary biochemical studies (parathormone washout, intraoperative parathormone monitoring (IPM)) and additional imaging (intraoperative USG) or radioguided approach can be used, which offers lower morbidity rates and similar success rates when compared to conventional methods, and this procedure yields good outcomes.

There are multiple MIP methods, and our clinic uses open mini-incision focused surgical technique. In this report, diagnosis and treatment methods of the disease are discussed.

The most critical factor regarding surgical success and treatment is the surgeon. If the appropriate surgical technique is selected according to the patient’s condition, those surgeons experienced in endocrine surgery can safely apply open MIP.

Keywords

Hypercalcemia Hyperparathyroidism Minimally invasive surgery Focused surgery Parathormone washout Intraoperative US Endocrine surgeon 

References

  1. 1.
    Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons Guidelines for definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016;15:959–68. PIMD:27532368.CrossRefGoogle Scholar
  2. 2.
    Bilezikian JP, Cusano NE, Khan AA, Liu JM, Marcocci C, Bandeira F. Primary hyperparathyroidism. Nat Rev Dis Primers. 2017;2:16033. PMCID: PMC5385896.CrossRefGoogle Scholar
  3. 3.
    Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surg. 2015;4:410–9.  https://doi.org/10.3978/j.issn.2227-684X.2015.03.07. PMCID: PMC4561661.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Guerin C, Aoife L, Gabriel S, Castinetti F, Philippon M, Vaillant-Lombard J, et al. Preoperative imaging for focused parathyroidectomy: making a good strategy even better. Eur J Endocrinol. 2015;172:519–26. PIMD:25637075.CrossRefGoogle Scholar
  5. 5.
    O’Doherty MJ, Kettle AG, Wells P, Collins RE, Coakley AJ. Parathyroid imaging with technetium 99m Sestamibi: preoperative localization and tissue uptake studies. J Nucl Med. 1992;33:313–8. PIMD:1531500.PubMedGoogle Scholar
  6. 6.
    Kim WW, Rhee Y, Ban EJ, Lee CR, Kang SW, Jeong JJ, et al. Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism. Ann Surg Treat Res. 2016;91:97–103. PMID:27617249.CrossRefGoogle Scholar
  7. 7.
    Kuzu F, Arpacı D, Çakmak GK, Emre AU, Elri T, Ilıkhan SU, et al. Focused parathyroidectomy without intra operative parathormone monitoring. The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout. Ann Med Surg. 2016;8:64–7. PIMD:26955476.CrossRefGoogle Scholar
  8. 8.
    Clark OH, Duh QY. Primary hyperparathyroidism, a surgical perspective. Endocrinol Method Clin North Am. 1989;18:701.CrossRefGoogle Scholar
  9. 9.
    Bakkar S, Matteucci V, Corsini C, Pagliaro S, Miccoli P. Less is more: time to expand the indications for minimally invasive video assisted parathyroidectomy. J Endocrinol Investig. 2017;40:979–83.CrossRefGoogle Scholar
  10. 10.
    Gioviale MC, Damiano G, Altomare R, Maione C, Buscemi S, Buscemi G, et al. Intraoperative measurement of parathyroid hormone: a Copernican revolution in the surgical treatment of hyperparathyroidism. Int J Surg. 2016;28(Suppl 1):S99–102. PIMD:26708859.CrossRefGoogle Scholar
  11. 11.
    Babunga ID, McHenry CR. Is intraoperative parathyroid hormone monitoring necessary for primary hyperparathyoidism with concordant preoperative imaging? Am J Surg. 2017;213:484–8. PIMD: 28017299.CrossRefGoogle Scholar
  12. 12.
    Aspinall SR, Nicholson S, Bliss RD, Lennard TW. The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice. Ann R Coll Surg Engl. 2012;94:17–22. PMID:22524912.CrossRefGoogle Scholar
  13. 13.
    Singh-ospina NM, Rodriquez-Gutierren R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis. World J Surg. 2016;40(10):2359–77. PMID:27094563.CrossRefGoogle Scholar
  14. 14.
    Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg. 2012;214(3):260–9. PMID:22265807.CrossRefGoogle Scholar
  15. 15.
    Norlen O, Wang KC, Tay JK, Johnson WR, Gredski S, Yeung M, et al. No need to abandon focused parathyroidectomy: a multicenter study of long term outcome after surgery for primary Hyperpatathyroidism. Ann Surg. 2015;261:991–6. PIMD:25565223.CrossRefGoogle Scholar
  16. 16.
    Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38(Suppl 1):E300–6. PMID: 25545792.CrossRefGoogle Scholar
  17. 17.
    Melfa GI, Rasponto C, Attard M, Cocorullo G, Attard A, Mazzola S, et al. Comparision of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis. G Chir. 2016;37:61–7. PMID:27381690.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Agarwal G, Barraclough BH, Reeve TS, Delbridge LV. Minimally invasive Parathyroidectomy using the “focused” lateral approach. II surgical technique. ANZ J Surg. 2002;72:147–51.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Orhan Yalçın
    • 1
  • Semra Günay
    • 1
  1. 1.University of Health Sciences (SBÜ), Okmeydanı Training and Research Hospital, Division of Breast and Endocrin Surgery, OkmeydanıIstanbulTurkey

Personalised recommendations