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Review
. 2011 May;93(4):290-3.
doi: 10.1308/003588411X571836.

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

W Wong  1 , F J Foo, M I Lau, A Sarin, P Kiruparan
Affiliations
Review

Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

W Wong et al. Ann R Coll Surg Engl. 2011 May.

Abstract

Introduction: Conventional practice of parathyroidectomy has been collar incision with bilateral neck exploration and a four-gland evaluation. Our local practice involves simplified parathyroidectomy via mini-incision without routine use of intraoperative adjuncts. The aim of this study is to demonstrate that a good success rate can be achieved, which will hopefully encourage more to undertake minimally invasive parathyroid surgery.

Materials and methods: A prospective case series of the first 100 patients undergoing minimally invasive parathyroidectomy (MIP) by a single surgeon at a single institution were included. Preoperatively, patients underwent ultrasonography (US) and/or a sestamibi (MIBI) scan for localisation. Parathyroidectomy was performed following an algorithm of intraoperative decisions. Serum calcium and/or parathyroid hormone levels were checked at follow-up. Postoperative normocalcaemia was considered success independent of serum parathyroid hormone levels

Results: The patients had a median age of 63 years. Of the 100 patients, 83 were female and 17 male. Seven patients had a conversion to bilateral exploration. The mean operative time for unilateral and bilateral exploration was 42.38 minutes and 76.43 minutes respectively. Separately, a MIBI scan and US lateralised the side of the lesion in 82.8% and 79.5% of cases respectively. When US and the MIBI scan agreed, the predictive accuracy of the side of the lesion was 87.5%. The majority of patients (96%) had a successful return to normocalcaemia. No complications were encountered.

Conclusions: Excellent results are achievable with simplified MIP even without intraoperative adjuncts. Preoperative localisation is helpful in determining the side of incision. Our technique demonstrates a key principle of surgery: to keep things simple.

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Figures

Figure 1
Figure 1
Algorithm of intraoperative decisions in simplified minimally invasive parathyroidectomy
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