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1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Suliburk, James W. Sywak, Mark S. Sidhu, Stan B. Delbridge, Leigh W.
Spatial Coverage	New South Wales
Description	Country affiliation: United States Author Affiliation: Suliburk JW ( Baylor College of Medicine, Department of Surgery, Houston, Texas, USA.)
Abstract	BACKGROUND: Minimally invasive parathyroidectomy (MIP) has become the procedure of choice in the treatment of primary hyperparathyroidism where a single adenoma can be localized preoperatively. The role for intra-operative parathyroid hormone measurement (IOPTH) is controversial. Some experts recommend that IOPTH is a mandatory requirement for successful MIP while others state that the technique is not needed. We reviewed 10 years of MIP in a single unit without the use of IOPTH in order to examine causes of failure. METHODS: This study is a retrospective review of the University of Sydney Endocrine Surgery Database from May of 1998 to August of 2008. The database was queried for MIPs performed as well as for failed operations. Patient record analysis was completed to determine the reason for failure of the operation. RESULTS: In the period January 1998 to August 2008, a total of 2343 parathyroidectomy procedures were performed. Of these, 1020 were MIPs with 23 (2.2%) failures. One patient was found to have benign familial hypercalcemia, whereas five were lost to follow-up. Reasons for failure in the remaining 17 patients were: 10 patients (59%) were found to have double adenomas, 3 (17%) patients with hyperplasia and 4 (24%) patients with single gland disease were missed at initial operation. All 17 were cured on repeat exploration. CONCLUSION: MIP can be performed safely and with 98% success without the need for IOPTH. The most common cause of failure after MIP is an occult double adenoma. Given that repeat sestamibi scan correctly identifies persistent disease in most cases, consideration can be given to MIP as a choice of procedure for repeat operation.
File Format	HTM / HTML
ISSN	14451433
Issue Number	5
Volume Number	81
e-ISSN	14452197
Journal	ANZ Journal of Surgery
Language	English
Publisher	Wiley
Publisher Date	2011-05-01
Publisher Place	Australia
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline General Surgery Medical Audit Monitoring, Intraoperative Parathyroid Hormone Blood Parathyroidectomy Methods Female Humans Male Middle Aged Minimally Invasive Surgical Procedures New South Wales Reoperation Retrospective Studies Treatment Failure Treatment Outcome Journal Article
Content Type	Text
Resource Type	Article
Subject	Surgery

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