One hundred consecutive minimally invasive parathyroid explorations.

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.