What's in a name?: Providing clarity in the definition of minimally invasive parathyroidectomy

Abstract

Background: In recent years minimally invasive parathyroidectomy has become the procedure of choice for many surgeons, but the meaning of the term is unclear. This is confusing for both the medical community and patients. We hypothesize that because the definition of minimally invasive parathyriodectomy in the literature is so variable this term has little meaning.

Methods: We performed a Pubmed search using the terms: parathyroidectomy, minimally invasive, localized, focused, unilateral, radio-guided, video-assisted, and endoscopic. Data were collected for: author, journal title, year published, and all described aspects of parathyroidectomy.

Results: We analyzed 443 (44%) articles after applying the exclusion criteria. Eighteen words were used in 75 different combinations to describe minimally invasive parathyroidectomy. We established four categories that encompassed all 75 definitions: 1. operative approach (incision size, describing as open; endoscopic; robotic; or video-assisted), 2. number of glands explored, 3. operative adjuncts, and 4. anesthesia type. Operative approach was the most commonly described attribute and was mentioned in 47% (n = 207) of the articles (mean incision size was found to be 2.2 cm), followed by number of glands explored, operative adjuncts, and anesthesia type.

Conclusions: The finding that there are 75 different definitions for minimally invasive parathyroidectomy confirms that this term is too generic to be useful. We propose a new taxonomic format to describe minimally invasive parathyroidectomy based on the four descriptive categories identified: (operative approach), (# of glands explored), parathyroidectomy using (operative adjuncts) under (anesthesia type). For example, "2 cm, single gland parathyroidectomy using intraoperative parathyroid hormone measurement, under general anesthesia".