One hundred consecutive minimally invasive parathyroid explorations

Abstract

Objective: To review the outcomes of 100 consecutive minimally invasive parathyroid explorations.

Summary background data: Minimally invasive parathyroidectomy (MIP) has challenged the traditional approach of bilateral neck exploration for patients with primary hyperparathyroidism. Most patients with primary hyperparathyroidism have a single adenoma that when resected results in cure. It therefore appears logical to perform a directed approach to adenoma extirpation. MIP involves high-quality sestamibi images obtained with single photon emission computed tomography to localize enlarged parathyroid glands in three dimensions, limited exploration after surgeon-administered cervical block anesthesia, rapid intraoperative parathyroid hormone assay to confirm the adequacy of resection, and discharge within 1 to 3 hours of surgery.

Methods: MIP was offered to 100 selected consecutive patients during an 18-month period beginning in March 1998.

Results: Ninety-two cases were accomplished under cervical block anesthesia and 89 of these on an ambulatory basis. The cure rate was 100%, and there were no long-term complications. The mean hospital charge for MIP was less than 40% of that associated with traditional exploration.

Conclusions: Outpatient MIP appears to be the procedure of choice for most patients with primary hyperparathyroidism.

Figure 1. Bar graph demonstrating the indications for exclusion from minimally invasive parathyroidectomy in 38 patients. Some patients had more than one indication for exclusion.

Figure 2. Symptoms and signs of primary hyperparathyroidism in 100 consecutive minimally invasive parathyroidectomy patients. Some patients had more than one symptom or sign.

Figure 3. Intraoperative parathyroid hormone (PTH) levels in 100 consecutive minimally invasive parathyroidectomies. The data are plotted as the percentage reduction in PTH levels from baseline to postresection values in individual patients.

Figure 4. Surgical minutes (mean ± SEM) recorded by the anesthesiologist in the minimally invasive parathyroidectomy (MIP) procedures performed under regional anesthesia compared with those converted to general anesthesia.

Figure 5. Length of stay (LOS) in 100 consecutive minimally invasive parathyroidectomy patients.

Figure 6. Serum total calcium levels in 100 consecutive minimally invasive parathyroidectomy patients. The preoperative levels were obtained during the preoperative evaluation. The postoperative values were obtained 7 days after surgery. The long-term values were obtained with a mean follow-up of 8 months. Data are presented as the group mean ± SEM. The gray area represents the reference range.

Figure 7. Serum parathyroid hormone (PTH) levels obtained before surgery and 7 days after surgery. Group data are presented as mean ± SEM. The gray area represents the reference range.

Figure 8. Total hospital charges (mean ± SEM) in 100 consecutive minimally invasive parathyroidectomy (MIP) patients. The first bar includes all 100 patients. The other bars compare the patients who were admitted with those who were discharged immediately after surgery.

Figure 9. Total hospital charges (mean ± SEM) comparing all minimally invasive parathyroidectomy (MIP) patients with those who underwent conventional exploration.