Abstract
Since the first parathyroidectomy in 1925, the traditional bilateral cervical approach has been the gold standard surgical treatment for patients with primary hyperparathyroidism, with a success rate >95%. Over the past decade, the focus on minimally invasive surgery has led to the development of several innovative approaches to the parathyroid glands including the focused, radio-guided, video-assisted and videoscopic parathyroidectomy. Improvements in pre-operative parathyroid localization studies as well as the use of the intraoperative PTH assay have made these minimally invasive approaches possible, and they have been proven to be safe and effective for the solitary parathyroid adenoma. For patients with multiple gland disease or equivocal localization studies, the traditional bilateral approach remains the standard of care.
Similar content being viewed by others
References
Welbourn RB. The history of endocrine surgery. New York: Praeger. 1990, 217–35.
Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh Q-Y. Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 2003, 138: 1140–3.
Clark OH. Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab 1995, 6: 1–16.
Sosa JA, Powe NR, Levine MA, Udelsman R, Zeiger MA. Profiles of a clinical practice: thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons. J Clin Endocrinol Metab 1998, 83: 2658–65.
Malmaeus J, Ganberg PO, Halvorsen J, et al. Parathyroid surgery in Scandinavia. Acta Chir Scand 1988, 154: 409–13.
Sebag F, Shen W, Brunaud L, Kebebew E, Duh Q-Y, Clark OH. Intraoperative parathyroid hormone assay and parathyroid reoperations. Surgery 2003, 134: 1049–56.
Clark OH, Way LW, Hunt T. Recurrent hyperparathyroidism. Ann Surg 1976, 184: 391–402.
Lorenz K, Miccoli P, Monchik JM, Duren M, Dralle H. Minimally invasive videoassisted parathyroidectomy: multiinstitutional study. World J Surg 2001, 25: 704–7.
Irvin III GL, Molinari AS, Figueroa C, Carneiro DM. Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg 1999, 229: 874–8.
Perrier N, Ituarte P, Morita E, et al. Parathyroid surgery—separating promise from reality. J Clin Endocrinol Metab 2002, 87: 1024–9.
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.
Genc H, Morita E, Perrier ND, et al. Differing histologic findings after bilateral and focused parathyroidectomy. J Am Coll Surg 2003, 196: 535–40.
Norman J, Chheda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 1997, 122: 998–1003.
Miccoli P, Bendinelli C, Conte M, Pinchera A, Marcocci C. Endoscopic parathyroidectomy through a gasless approach. J Laparoendosc Adv Surg Tech A 1998, 8: 189–94.
Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996, 83: 875.
Milas M, Wagner K, Easley KA, Siperstein AE, Weber CJ. Double adenomas revisited: nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease). Surgery 2003, 134: 995–1004.
Bergon EJ, Heller KS. The clinical significance and anatomic distribution of parathyroid double adenomas. J Am Coll Surg 2004, 198: 185–9.
Haciyanli M, Lal G, Morita E, Duh Q-Y, Clark OH. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg 2003, 197: 739–46.
Gauger PG, Agarwal G, England BG, et al. Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery 2001, 130: 1005–10.
Weber CJ, Ritchie JC. Retrospective analysis of sequential changes in serum intact parathyroid hormone levels during conventional parathyroid exploration. Surgery 1999, 126: 1139–43.
Schacther P P, Ayesh SA, Schneider T, Laster M, Czerniak A, Hochberg A. Expression of kinase genes in primary hyperparathyroidism: adenoma versus hyperplastic parathyroid tissue. Surgery 2002, 132: 1094–9.
Bentrem DJ, Angelos P, Talamonti MS, Nayar R. Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid 2002, 12: 1109–12.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ogilvie, J.B., Clark, O.H. Parathyroid surgery: We still need traditional and selective approaches. J Endocrinol Invest 28, 566–569 (2005). https://doi.org/10.1007/BF03347248
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03347248