Trolle Waldemar, Møller Henrik, Bennedbaek Finn Noe, Nygaard Birte, Sørensen Christian Hjort
Øre-naese-halskirurgisk Afdeling, Gentofte Hospital, DK-2900 Hellerup, Denmark.
Ugeskr Laeger. 2010 Jan 4;172(1):33-8.
The traditional surgical approach for primary hyperparathyroidism (PHPT) involves a bilateral neck exploration to identify all parathyroid glands and remove the suspected pathological parathyroid gland(s). However, with improved preoperative imaging modalities and the use of perioperative measuring of PTH the unilateral minimal invasive approach has been introduced. The purpose of this study was to describe the results of minimal invasive parathyroidectomy.
A total of 116 consecutive patients underwent PHPT surgery (117 procedures) with a minimal invasive approach.
A true positive sestamibi scintigraphy was found in 75 of 116 (65%) cases. A total of 80 patients (69%) underwent a unilateral surgical procedure and 56 patients (48%) minimally invasive surgery. In 113 of 117 procedures one or more pathological parathyroid glands were found. The median duration of the surgical procedure was 55 minutes and only 35 minutes for the minimal invasive approach. No permanent vocal cord paralysis was found. In two patients, persistent mild hypercalcaemia was encountered postoperatively and in a further patient recurrence was seen one year after.
In our hands the success rate for focused minimal invasive surgery for the treatment of PHPT is equal to or better than results obtained by the traditional bilateral neck exploration. The minimally invasive approach is a less time-consuming and safe procedure with a low complication rate. Postoperative hypocalcaemia is rare and further advantages include improved cosmetic results and reduced surgical trauma.
