Hyperparathyroidism surgery: Difference between revisions
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*MIP increases safety and cost-effectiveness in patients with preoperative localization of hyper-functioning parathyroid glands. | *MIP increases safety and cost-effectiveness in patients with preoperative localization of hyper-functioning parathyroid glands. | ||
*Hyper-functioning parathyroid glands are excised and operative cure is confirmed by rapid intraoperative PTH assay.<ref name="pmid19193911">{{cite journal| author=Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH| title=Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 2 | pages= 366-72 | pmid=19193911 | doi=10.1210/jc.2008-1761 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19193911 }} </ref><ref name="pmid19763685">{{cite journal| author=Fraker DL, Harsono H, Lewis R| title=Minimally invasive parathyroidectomy: benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. long-term results. | journal=World J Surg | year= 2009 | volume= 33 | issue= 11 | pages= 2256-65 | pmid=19763685 | doi=10.1007/s00268-009-0166-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19763685 }} </ref> | *Hyper-functioning parathyroid glands are excised and operative cure is confirmed by rapid intraoperative PTH assay.<ref name="pmid19193911">{{cite journal| author=Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH| title=Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 2 | pages= 366-72 | pmid=19193911 | doi=10.1210/jc.2008-1761 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19193911 }} </ref><ref name="pmid19763685">{{cite journal| author=Fraker DL, Harsono H, Lewis R| title=Minimally invasive parathyroidectomy: benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. long-term results. | journal=World J Surg | year= 2009 | volume= 33 | issue= 11 | pages= 2256-65 | pmid=19763685 | doi=10.1007/s00268-009-0166-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19763685 }} </ref> | ||
*MIP provides excellent postoperative cure rates comparable to bilateral neck exploration. This is due to precise preoperative localization of hyper-functioning parathyroid gland and use of intraoperative parathyroid hormone (IOPTH) monitoring for predicting postsurgical success (postoperative normocalcemia). | *MIP provides excellent postoperative cure rates comparable to bilateral neck exploration. This is due to precise preoperative localization of hyper-functioning parathyroid gland and use of intraoperative parathyroid hormone (IOPTH) monitoring for predicting postsurgical success (postoperative normocalcemia).<ref name="pmid11114625">{{cite journal| author=Carneiro DM, Irvin GL| title=Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. | journal=Surgery | year= 2000 | volume= 128 | issue= 6 | pages= 925-9;discussion 935-6 | pmid=11114625 | doi=10.1067/msy.2000.109964 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11114625 }} </ref> | ||
===Bilateral neck exploration=== | ===Bilateral neck exploration=== |
Revision as of 14:13, 6 September 2017
Hyperparathyroidism Microchapters |
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Treatment |
Case Studies |
Hyperparathyroidism surgery On the Web |
American Roentgen Ray Society Images of Hyperparathyroidism surgery |
Risk calculators and risk factors for Hyperparathyroidism surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
- Surgery is the mainstay of treatment for hyperparathyroidism.
- Symptomatic hyperparathyroidism is an indication for surgery. However, there are guidelines for surgery in asymptomatic priamry hyperparathyroidism.[1]
Guidelines for Surgery in Asymptomatic PHPT | |
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Factors | Criteria |
Serum calcium | 1.0 mg/dL (0.25 mmol/L) (>upper limit of normal) |
Skeletal: |
|
Renal |
|
Age | <50 |
Consistent with the position established by the ISCD, the use of Z-scores instead of T-scores is recommended in evaluating BMD in premenopausal women and men younger than 50 y (11).
|
Minimally invasive parathyroidectomy
- Most commonly done surgery for hyperparathyroidism is minimally invasive parathyroidectomy (MIP).[2]
- MIP is usually done in loco-regional anesthesia.
- Various techniques for MIP includes:[3]
- Open minimally-invasive parathyroidectomy (OMI P)[4]
- Minimally-invasive radio-guided parathyroidectomy (MI-RP)
- Endoscopic parathyroidectomy (EP)[5]
- Minimally invasive video-assisted parathyroidectomy (MIVAP)[6]
- video-assisted parathyroidectomy through a lateral approach (VAP-LA)[7]
- Minimally-invasive radio-guided parathyroidectomy[8]
- Open minimally-invasive parathyroidectomy (OMI P) is the most commonly used Minimally invasive parathyroidectomy.[9]
- MIP increases safety and cost-effectiveness in patients with preoperative localization of hyper-functioning parathyroid glands.
- Hyper-functioning parathyroid glands are excised and operative cure is confirmed by rapid intraoperative PTH assay.[10][11]
- MIP provides excellent postoperative cure rates comparable to bilateral neck exploration. This is due to precise preoperative localization of hyper-functioning parathyroid gland and use of intraoperative parathyroid hormone (IOPTH) monitoring for predicting postsurgical success (postoperative normocalcemia).[12]
Bilateral neck exploration
- Bilateral neck exploration (BNE) is the traditional surgery for hyperparathyroidism.
- BNE is usually done under general anesthesia.
- BNE is used less commonly as outcomes is comparable to MIP.
Minimally invasive parathyroidectomy (MIP) is preferred over BNE due to following reasons:[13][14]
- MIP has similar success rate as BNE.
- Rate of complications is low in MIP compared to BNE.
- Operating time is reduced to almost half in MIP compared to BNE.
- Hospital stay is reduced by seven folds after MIP compared to BNE.
- MIP results in a mean cost savings of $2,693 per procedure compared to BNE accounting to approximately 50% reduction in total hospital charges.
- MIP has lower incidence of post-operative severe symptomatic hypocalcemia compared to BNE.
References
- ↑ Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C; et al. (2014). "Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop". J Clin Endocrinol Metab. 99 (10): 3561–9. doi:10.1210/jc.2014-1413. PMC 5393490. PMID 25162665.
- ↑ Miccoli, P.; Monchik, J. M. (2000). "Minimally invasive parathyroid surgery" (PDF). Surgical Endoscopy. 14 (11): 987–990. doi:10.1007/s004640000192. ISSN 0930-2794.
- ↑ Bellantone R, Raffaelli M, DE Crea C, Traini E, Lombardi CP (2011). "Minimally-invasive parathyroid surgery". Acta Otorhinolaryngol Ital. 31 (4): 207–15. PMC 3203720. PMID 22065831.
- ↑ Agarwal G, Barraclough BH, Reeve TS, Delbridge LW (2002). "Minimally invasive parathyroidectomy using the 'focused' lateral approach. II. Surgical technique". ANZ J Surg. 72 (2): 147–51. PMID 12074068.
- ↑ Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT (1998). "Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy". Surg Endosc. 12 (3): 202–5, discussion 206. PMID 9502695.
- ↑ Miccoli P, Berti P, Conte M, Raffaelli M, Materazzi G (2000). "Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases". J Am Coll Surg. 191 (6): 613–8. PMID 11129809.
- ↑ Henry JF, Defechereux T, Gramatica L, de Boissezon C (1999). "Minimally invasive videoscopic parathyroidectomy by lateral approach". Langenbecks Arch Surg. 384 (3): 298–301. PMID 10437620.
- ↑ Norman J, Chheda H, Farrell C (1998). "Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results". Am Surg. 64 (5): 391–5, discussion 395-6. PMID 9585770.
- ↑ Sackett WR, Barraclough B, Reeve TS, Delbridge LW (2002). "Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy". Arch Surg. 137 (9): 1055–9. PMID 12215160.
- ↑ Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH (2009). "Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop". J Clin Endocrinol Metab. 94 (2): 366–72. doi:10.1210/jc.2008-1761. PMID 19193911.
- ↑ Fraker DL, Harsono H, Lewis R (2009). "Minimally invasive parathyroidectomy: benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. long-term results". World J Surg. 33 (11): 2256–65. doi:10.1007/s00268-009-0166-4. PMID 19763685.
- ↑ Carneiro DM, Irvin GL (2000). "Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration". Surgery. 128 (6): 925–9, discussion 935-6. doi:10.1067/msy.2000.109964. PMID 11114625.
- ↑ Udelsman R (2002). "Six hundred fifty-six consecutive explorations for primary hyperparathyroidism". Ann Surg. 235 (5): 665–70, discussion 670-2. PMC 1422492. PMID 11981212.
- ↑ Chen H (2002). "Surgery for primary hyperparathyroidism: what is the best approach?". Ann. Surg. 236 (5): 552–3. doi:10.1097/01.SLA.0000032950.78031.E6. PMC 1422610. PMID 12409658.