Abstract
The history of parathyroid surgery clearly illustrates how surgical pioneers, along with technical advances, have changed the surgical paradigm for primary hyperparathyroidism. Surgeons initially removed one gland, only to find that a bilateral neck exploration was needed to rule in or out multi-gland disease to ensure long-term cure. More recently, with the development of better imaging and intraoperative PTH, surgeons have moved towards a more focused approach to this disease. However, these technological advances and adjuncts are only tools, and not substitutes, for diligent surgical exploration. It is paramount that the next generation of endocrine surgeons has within their armamentarium an ability to safely and effectively perform a bilateral four-gland cervical exploration and to understand how to properly select patients for a less invasive approach.
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Abbott DE, Cantor SB, Grubbs EG, et al. Outcomes and economic analysis of routine preoperative 4-dimensional CT for surgical intervention in de novo primary hyperparathyroidism: does clinical benefit justify the cost? J Am Coll Surg. 2012;214:629–37; discussion 637–9.
Albright F. A page out of history of hyperparathyroidism. J Clin Endocrinol Metab. 1948;8:637–57.
Almquist M, Bergenfelz A, Martensson H, Thier M, Nordenstrom E. Changing biochemical presentation of primary hyperparathyroidism. Langenbecks Arch Surg. 2010;395:925–8.
Askanazy M. Ueber ostitis deformans ohne osteides. Arb Pathol Inst Tubingen. 1904;4:398–422.
Barr DP, Bulger HA, Dixon HH. Hyperparathyroidism. JAMA. 1929;92:951–2.
Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002;236:543–51.
Bergenfelz A, Kanngiesser V, Zielke A, Nies C, Rothmund M. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg. 2005;92:190–7.
Bergenfelz AO, Jansson SK, Wallin GK, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. 2009;394:851–60.
Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2010;54:106–9.
Caron NR, Pasieka JL. What symptom improvement can be expected after operation for primary hyperparathyroidism? World J Surg. 2009;33:2244–55.
Carsello CB, Yen TW, Wang TS. Persistent elevation in serum parathyroid hormone levels in normocalcemic patients after parathyroidectomy: does it matter? Surgery. 2012;152:575–83.
Carty SE, Roberts MM, Virji MA, Haywood L, Yim JH. Elevated serum parathormone level after “concise parathyroidectomy” for primary sporadic hyperparathyroidism. Surgery. 2002;132:1086–92; discussion 1092–3.
Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg. 2003;238:332–7; discussion 337–8.
Chen H, Mack E, Starling JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg. 2005;242:375–80; discussion 380–3.
Chen HH, Lin CJ, Wu CJ, et al. Chemical ablation of recurrent and persistent secondary hyperparathyroidism after subtotal parathyroidectomy. Ann Surg. 2011;253:786–90.
Cirocchi R, Trastulli S, Boselli C, et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev. 2012;6, CD006317.
Cope O. The story of hyperparathyroidism at the Massachusetts General Hospital. N Engl J Med. 1966;274:1174–82.
D’Agostino J, Diana M, Vix M, Soler L, Marescaux J. Three-dimensional virtual neck exploration before parathyroidectomy. N Engl J Med. 2012;367(11):1072–3.
Donatini G, Materazzi G, Miccoli P. The endoscopic approach to the neck: a review of the literature and an overview of the various techniques. Surg Endosc. 2012;26:287.
Doppman JL. Reoperative parathyroid surgery; localization procedures. Prog Surg. 1986;18:117–32.
Eastell R, Arnold A, Brandi ML, et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:340–50.
Felger EA, Kandil E. Primary hyperparathyroidism. Otolaryngol Clin North Am. 2010;43:417–32, x.
Ferlin G, Borsato N, Camerani M, Conte N, Zotti D. New perspectives in localizing enlarged parathyroids by technetium-thallium subtraction scan. J Nucl Med. 1983;24:438–41.
Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012;26:2259–66.
Fraker DL, Harsono H, Lewis R. Minimally invasive parathyroidectomy: benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. long-term results. World J Surg. 2009;33:2256–65.
Fraser WD. Hyperparathyroidism. Lancet. 2009;374:145–58.
Genc V, Agcaoglu O, Berber E. Robotic endocrine surgery: technical details and review of the literature. J Robot Surg. 2012;6:85–97.
Goldfarb M, Gondek S, Irvin 3rd GL, Lew JI. Normocalcemic parathormone elevation after successful parathyroidectomy: long-term analysis of parathormone variations over 10 years. Surgery. 2011;150:1076–84.
Harman CR, Grant CS, Hay ID, et al. Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery. 1998;124:1011–9; discussion 1019–20.
Harness JK. Invited commentary on “Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach?”. World J Surg. 1990;14:409.
Harris R, Ryu H, Vu T, et al. Modern approach to surgical intervention of the thyroid and parathyroid glands. Semin Ultrasound CT MR. 2012;33:115–22.
Henry JF, Defechereux T, Gramatica L, de Boissezon C. Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbecks Arch Surg. 1999;384:298–301.
Hessman O, Westerdahl J, Al-Suliman N, Christiansen P, Hellman P, Bergenfelz A. Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism. Br J Surg. 2010;97:177–84.
Ikeda Y, Takami H. Endoscopic parathyroidectomy. Biomed Pharmacother. 2000;54 Suppl 1:52s–656.
Irvin 3rd GL, Prudhomme DL, Deriso GT, Sfakianakis G, Chandarlapaty SK. A new approach to parathyroidectomy. Ann Surg. 1994;219:574–9; discussion 579–81.
Irvin 3rd GL, Sfakianakis G, Yeung L, et al. Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg. 1996;131:1074–8.
Irvin 3rd GL, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg. 2004;239:704–8; discussion 708–11.
Jarrige V, Nieuwenhuis JH, van Son JP, Martens MF, Vissers JL. A fast intraoperative PTH point-of-care assay on the Philips handheld magnotech system. Langenbecks Arch Surg. 2011;396:337–43.
Kovatcheva RD, Vlahov JD, Shinkov AD, et al. High-intensity focused ultrasound to treat primary hyperparathyroidism: a feasibility study in four patients. AJR Am J Roentgenol. 2010;195:830–5.
Kunstman JW, Udelsman R. Superiority of minimally invasive parathyroidectomy. Adv Surg. 2012;46:171–89.
Lew JI, Solorzano CC. Surgical management of primary hyperparathyroidism: state of the art. Surg Clin North Am. 2009;89:1205–25.
Miccoli P, Bendinelli C, Conte M, Pinchera A, Marcocci C. Endoscopic parathyroidectomy by a gasless approach. J Laparoendosc Adv Surg Tech A. 1998;8:189–94.
Miccoli P, Materazzi G, Berti P. Natural orifice surgery on the thyroid gland using totally transoral video-assisted thyroidectomy: report of the first experimental results for a new surgical method: are we going in the right direction? Surg Endosc. 2010;24:957–8; author reply 959–60.
Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg. 2007;94:42–7.
Mihai R, Barczynski M, Iacobone M, Sitges-Serra A. Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations. Langenbecks Arch Surg. 2009;394:785–98.
Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT. Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc. 1998;12:202–5; discussion 206.
Norman J, Politz D. 5,000 parathyroid operations without frozen section or PTH assays: measuring individual parathyroid gland hormone production in real time. Ann Surg Oncol. 2009;16:656–66.
Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg. 2012;214:260–9.
Owen R. On the anatomy of the Indian Rhinoceros. Tran Zool Soc Lon. 1862;4:31–58.
Rahbar K, Colombo-Benkmann M, Haane C, et al. Intraoperative 3-D mapping of parathyroid adenoma using freehand SPECT. EJNMMI Res. 2012;2:51.
Riss P, Scheuba C, Asari R, Bieglmayer C, Niederle B. Is minimally invasive parathyroidectomy without QPTH monitoring justified? Langenbecks Arch Surg. 2009;394:875–80.
Rodgers SE, Hunter GJ, Hamberg LM, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006;140:932–40; discussion 940–1.
Roth SL, Wang C-A, Potts JT. The team approach to primary hyperparathyroidism. Hum Pathol. 1975;6:645–8.
Russell C. Unilateral neck exploration for primary hyperparathyroidism. Surg Clin North Am. 2004;84:705–16.
Schlagenhaufer F. Zwei falle von parathyroideatumoren. Wien Kiln Wochenschr Zentral. 1915;28:1362.
Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012;152:1008–15.
Shiina S, Tateishi R, Imamura M, et al. Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors. Liver Int. 2012;32:1434–42.
Shin JE, Baek JH, Lee JH. Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol. 2013;25:14–9.
Sidhu S, Neill AK, Russell CF. Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma. World J Surg. 2003;27:339–42.
Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:351–65.
Siperstein A, Berber E, Barbosa GF, et al. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008;248:420–8.
Stalberg P, Sidhu S, Sywak M, Robinson B, Wilkinson M, Delbridge L. Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: does it “value-add” to decision-making? J Am Coll Surg. 2006;203:1–6.
Terris DJ, Stack BCJ, Gourin CG. Contemporary parathyroidectomy: exploiting technology. Am J Otolaryngol. 2007;28:408–14.
Terris DJ, Weinberger PM, Farrag T, Seybt M, Oliver JE. Restoring point-of-care testing during parathyroidectomy with a newer parathyroid hormone assay. Otolaryngol Head Neck Surg. 2011;145:557–60.
Thompson NW. The history of hyperparathyroidism. Acta Chir Scand. 1990;156:5–21.
Tibblin S, Bondeson A-G, Ljungberg O. Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg. 1982;195:245–52.
Twigt BA, van Dalen T, Vollebregt AM, Kortlandt W, Vriens MR, Borel Rinkes IH. The additional value of intraoperative parathyroid hormone assessment is marginal in patients with nonfamilial primary hyperparathyroidism: a prospective cohort study. Am J Surg. 2012;204:1–6.
Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253:585–91.
Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery. 2005;138:1130–5; discussion 1135–6.
Willatt JM, Francis IR, Novelli PM, Vellody R, Pandya A, Krishnamurthy VN. Interventional therapies for hepatocellular carcinoma. Cancer Imaging. 2012;12:79–88.
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Pasieka, J.L. (2014). Parathyroid Surgery 2020. In: Terris, D., Singer, M. (eds) Minimally Invasive and Robotic Thyroid and Parathyroid Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9011-1_20
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DOI: https://doi.org/10.1007/978-1-4614-9011-1_20
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