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Parathyroid surgery: We only need a minimal surgical approach

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Abstract

Minimally invasive surgery for the treatment of primary hyperparathyroidism is currently used by the greatest majority of authors. Extensive literature has shown that results and complication rates are comparable to those obtained by extensive neck bilateral exploration performed via standard open surgery. Neither recurrence rate nor persistence rate have increased over the last 7 yr since the introduction of these minimal access procedures. The dramatic improvement of localization studies and the introduction of intraoperative parathyroid hormone measurement constitute the basis for this change of attitude among surgeons; the shift has also been supported by the utilization of the new endoscopic techniques recently introduced. Bilateral neck exploration now seems to be confined only to a slight minority of patients, in particular when a reoperation or the removal of a big goiter is needed.

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References

  1. Duh QY. Presidential Address: Minimally invasive endocrine surgery-standard of treatment or hype? Surgery 2003, 134: 849–57.

    Article  PubMed  Google Scholar 

  2. Sackett WR, Barraclough B, Reeve TS, Delbridge W. World wide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002, 137: 1055–9.

    Article  PubMed  Google Scholar 

  3. Tibblin S, Bondeson A-G, Ljungberg O. Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 1982, 195: 245–52.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Denham DW, Norman J. Bilateral neck exploration for all parathyroid patients is an operation for the history books. Surgery 2003, 133: 513.

    Article  Google Scholar 

  5. Udelsman R. Six Hundred Fifty-Six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002, 235: 665–72.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Irvin GL, Carneiro DM, Solorzano CC. Progress in the management of sporadic primary hyperparathyroidism over 34 years. Ann Surg 2004, 239: 704–11.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Miccoli P, Cecchini G, Conte M, et al. Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 1997, 20: 429–30.

    CAS  PubMed  Google Scholar 

  8. Russell C. Unilateral neck exploration for primary hyperparathyroidism. Surg Clin North Am, 84: 705–16.

  9. Henry JF, Jacobone M, Mirallie M, et al. Indications and results of video assisted parathyroidectomy by a lateral approach in patients with a primary hyperparathyroidism. Surgery 2001, 130: 999–1004.

    Article  CAS  PubMed  Google Scholar 

  10. Berti P, Materazzi G, Picone A, Miccoli P. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003, 90: 743–7.

    Article  CAS  PubMed  Google Scholar 

  11. Mourad M, Pugin F, Elias B, et al. Contributions of the videoassisted approach to thyroid and parathyroid surgery. Acta Chir Belg 2002, 102: 523–7.

    Google Scholar 

  12. Hallfeldt KKJ, Trupka A, Gallwas J, Schmidbauer S. Minimally invasive video assisted parathyroidectomy and intra operative parathyroid hormone monitoring. Surg Endosc 2002, 16: 1759–63.

    Article  CAS  PubMed  Google Scholar 

  13. Eigelberger MS, Clark OH. Surgical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am 200, 29: 479–502.

  14. Bergenfeltz A, Lindblom P, Tibblin S, Westrdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002, 236: 543–51.

    Article  Google Scholar 

  15. Siperstein A, Berber E, Mackey R, Alghoul M, Wagner K, Milas M. Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery 2004, 136: 872–80.

    Article  PubMed  Google Scholar 

  16. Miccoli P, Berti P, Materazzi G, Massi M, Picone A, Minuto M. Results of video-assisted parathyroidectomy: single Institution’s six-year experience. World J Surg (on line 11 November 2004).

  17. Vignali E, Picone A, Materazzi G, et al. A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 2002, 146: 783–8.

    Article  CAS  PubMed  Google Scholar 

  18. Irvin GL 3rd, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg 2004, 239: 704–11.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Haciyanli M, Lal G, Morita E, Duh QY, Kebebew E, 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.

    Article  PubMed  Google Scholar 

  20. Gagner M, Rubino F. Endoscopic Parathyroidectomy. In: Minimally Invasive Endocrine Surgery. Philadelphia: Lippincott Williams and Wilkins Ed. 2002, 111.

    Google Scholar 

  21. Berti P, Materazzi G, Picone A, Miccoli P. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003, 90: 743–7.

    Article  CAS  PubMed  Google Scholar 

  22. Denham DW, Norman J. Bilateral neck exploration for all parathyroid patients is an operation for the history book. Surgery 2003, 133: 513.

    Article  Google Scholar 

  23. Mourad M, Pugin F, Elias B, et al. Contributions of the videoassisted approach to thyroid and parathyroid surgery. Acta Chir Belg 2002, 102: 523–7.

    Google Scholar 

  24. Fausto Palazzo F, Delbridge LW. Minimal access/minimally invasive parathyroidectomy for primari hyperparathyroidism. Surg Clin North Am 2004, 84: 717–34.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Chirurgia, Università degli Studi di Pisa, Azienda Ospedale Università di Pisa, Ospedale Santa Chiara, Via Roma 67, 56126, Pisa, Italy

    P. Miccoli MD

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  1. P. Miccoli MD
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Correspondence to P. Miccoli MD.

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Miccoli, P. Parathyroid surgery: We only need a minimal surgical approach. J Endocrinol Invest 28, 570–573 (2005). https://doi.org/10.1007/BF03347249

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