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Long-Term Success of Surgery for Primary Hyperparathyroidism: Focused Exploration using Intraoperative Parathyroid Hormone Monitoring Versus Four-Gland Exploration

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Difficult Decisions in Endocrine Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Primary hyperparathyroidism is a common problem that is a result of the excessive secretion of parathyroid hormone (PTH) from the parathyroid glands. This is most commonly caused by a single hypersecreting adenomatous gland. Most all patients with primary hyperparathyroidism meet criteria for surgery. The best operation should provide the highest rate of cure with the lowest rate of complications. The standard surgical approach has traditionally been a four-gland exploration. Though this method has endured many years of excellent cure rates, it has been challenged because a long-lasting cure is possible with the removal of a single adenoma in the majority of cases. Thus, a focused exploration via an image-guided, open unilateral exploration employing intraoperative PTH (ioPTH) monitoring has gained popularity over the last two decades. Specifically, ioPTH monitoring has been shown to be paramount to this approach, enabling a more limited exploration by accurately guiding gland excision and predicting postoperative cure. Several large series of focused parathyroid operations have shown excellent, durable cure rates similar to standard four-gland exploration. Focused exploration guided by ioPTH is a safe, effective technique that is recommended for most patients with sporadic primary hyperparathyroidism.

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  1. Department of Surgery, Oakland University William Beaumont School of Medicine, Beaumont Hospitals, Royal Oak, MI, USA

    Wesley Barnes, Peter F. Czako & Sapna Nagar

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    Peter Angelos

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Raymon H. Grogan

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Barnes, W., Czako, P.F., Nagar, S. (2018). Long-Term Success of Surgery for Primary Hyperparathyroidism: Focused Exploration using Intraoperative Parathyroid Hormone Monitoring Versus Four-Gland Exploration. In: Angelos, P., Grogan, R. (eds) Difficult Decisions in Endocrine Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-92860-9_21

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