Minimally Invasive Parathyroidectomy

Chapter

Abstract

Approximately 85% of patients with primary hyperparathyroidism (pHPT) harbor a single adenoma and are cured by excision of the incident gland. The remaining patients display double adenomas (3–5%) or four-gland hyperplasia (10–15%). Thus, with accurate preoperative localization, targeted surgery using unilateral neck exploration under regional or local anesthesia has been developed, evaluated over the past decade and has become the standard of care in an ever-increasing number of specialized centers. Unilateral surgery for pHPT was advocated in 1975, and the side to be explored was chosen based on palpation, esophageal imaging, venography, or arteriography. If both enlarged and normal gland were found on the initial side, then contralateral cervical exploration was obviated. Other authors advocated a similar approach, arguing that bilateral exploration increased the risk, cost, and morbidity of surgery for pHPT. The Lund University surgeons advocated unilateral parathyroidectomy, which they defined as removal of both an adenoma and ipsilateral normal parathyroid. The excised tissue was studied microscopically during surgery with Oil Red O, and the decision to stop the operation at this stage was based on demonstration of a reduction in intracytoplasmic fat droplets in the excised adenomatous parathyroid tissue. Both techniques would fail, however, in the setting of a double adenoma on the contralateral side and if the essentially “random” choice of which side to explore was incorrect. Today, minimally invasive parathyroidectomy (MIP) is performed after preoperative parathyroid localization usually with high-quality sestamibi scans, ultrasonograhpy, or four-dimensional parathyroid CT scans, often under cervical block anesthesia during which a focused exploration is performed, and the rapid intraoperative parathyroid hormone assay is employed to confirm an adequate resection.

Keywords

Parathyroid Gland Recurrent Laryngeal Nerve Parathyroid Adenoma Minimally Invasive Parathyroidectomy Bilateral Neck Exploration 
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.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of SurgeryYale University School of MedicineNew HavenUSA
  2. 2.Department of SurgeryYale University School of MedicineNew HavenUSA

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