Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature

Abstract

INTRODUCTION Conventional practice of parathyroidectomy has been collar incision with bilateral neck exploration and a four-gland evaluation. Our local practice involves simplified parathyroidectomy via mini-incision without routine use of intraoperative adjuncts. The aim of this study is to demonstrate that a good success rate can be achieved, which will hopefully encourage more to undertake minimally invasive parathyroid surgery. MATERIALS AND METHODS A prospective case series of the first 100 patients undergoing minimally invasive parathyroidectomy (MIP) by a single surgeon at a single institution were included. Preoperatively, patients underwent ultrasonography (US) and/or a sestamibi (MIBI) scan for localisation. Parathyroidectomy was performed following an algorithm of intraoperative decisions. Serum calcium and/or parathyroid hormone levels were checked at follow-up. Postoperative normocalcaemia was considered success independent of serum parathyroid hormone levels RESULTS The patients had a median age of 63 years. Of the 100 patients, 83 were female and 17 male. Seven patients had a conversion to bilateral exploration. The mean operative time for unilateral and bilateral exploration was 42.38 minutes and 76.43 minutes respectively. Separately, a MIBI scan and US lateralised the side of the lesion in 82.8% and 79.5% of cases respectively. When US and the MIBI scan agreed, the predictive accuracy of the side of the lesion was 87.5%. The majority of patients (96%) had a successful return to normocalcaemia. No complications were encountered. CONCLUSIONS Excellent results are achievable with simplified MIP even without intraoperative adjuncts. Preoperative localisation is helpful in determining the side of incision. Our technique demonstrates a key principle of surgery: to keep things simple.