Minimally Invasive Non-endoscopic Parathyroidectomy

Chapter

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.

Keywords

Fatigue Lithium Adenoma Assure Epinephrine 

Recommended Reading

  1. 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.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. Fancy T, Gallagher D, Hornig J. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin N Am. 2010;43:221–7.CrossRefGoogle Scholar
  13. Gracie D, Hussain S. Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review. J Laryngol Otol. 2012;126:221–7.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCentralPubMedGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. Hunter J. Minimally invasive surgery: the next frontier. World J Surg. 1999;23:422–4.PubMedCrossRefGoogle Scholar
  18. Kamaya A, Quon A, Jeffrey R. Sonography of the abnormal parathyroid gland. Ultrasound Q. 2006;22(4):253–62.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. Miccoli P, Materazzi G, Bonari G, et al. Minimally invasive video-assisted parathyroidectomy. Oper Tech Otolaryngol. 2008;19:22–5.CrossRefGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. Moreno M, Callender G, Woodburn K, et al. Common locations of parathyroid adenomas. Ann Surg Oncol. 2011;18:1047–51.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. Pellitteri P. Intraoperative assessment of parathyroid hormone. Oper Tech Otolaryngol. 2009;20:60–5.CrossRefGoogle Scholar
  29. Phillips C, Shatzkes D. Imaging of the parathyroid glands. Semin Ultrasound CT MR. 2012;33:123–9.PubMedCrossRefGoogle Scholar
  30. Prager G, Czerny C, Kurtaran A. Minimally invasive open parathyroidectomy in an endemic goiter area. Arch Surg. 2001;136:810–6.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. Richards M, Thompson G, Farley D, Grant C. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg. 2011;146(3):280–5.PubMedCrossRefGoogle Scholar
  33. Ritter H, Milas M. Bilateral parathyroid exploration for hyperparathyroidism. Oper Tech Otolaryngol. 2009;20:44–53.CrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. Stack B. Minimally invasive radioguided parathyroidectomy. Oper Tech Otolaryngol. 2009;20:54–9.CrossRefGoogle Scholar
  41. Starker L, Fonseca A, Carling T, Udelsman R. Minimally invasive parathyroidectomy. Int J Endocrinol. 2001;206502:1–8. Published Online 2011 May 23.Google Scholar
  42. Suliburk J, Perrier N. Primary hyperparathyroidism. Oncologist. 2007;12:644–53.PubMedCrossRefGoogle Scholar
  43. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235(5):665–72.PubMedCrossRefGoogle Scholar
  44. Udelsman R. Approach to the patient with persistent or recurrent primary hyperparathyroidism. J Clin Endocrinol Metab. 2011;96(10):2950–8.PubMedCrossRefGoogle Scholar
  45. Udelsman R, Carling C. Focused approach to parathyroidectomy. World J Surg. 2008;32:1512–7.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. Van Husen R, Kim L. Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg. 2004;28:1122–6.PubMedCrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. Zanocco K, Angelos P, Sturgeon C. Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery. 2006;140(6):874–81; discussion 881–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of OtolaryngologyGeorgia Regents UniversityAugustaUSA
  2. 2.Department of Otolaryngology – Head and Neck SurgeryGRU Thyroid Center, Georgia Regents UniversityAugustaUSA

Personalised recommendations