Minimally invasive parathyroidectomy: the Australian experience

Minimally invasive parathyroidectomy (MIP) was introduced into Australia after endocrine surgeons agreed that it should only be undertaken in the context of a feasibility study or controlled trial, and under the auspices of the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S). Feasibility of endoscopic-assisted parathyroidectomy was studied at Royal North Shore Hospital (RNS) and 49 cases were completed. Subsequently, the technique of a focused lateral approach using a 2-cm incision placed directly over the site of the localized adenoma was developed and has now become the standard technique for the unit. To date, 357 MIPs using the focused lateral approach have been performed with a 1.5% rate of negative neck exploration and a permanent recurrent laryngeal nerve palsy rate of 0.8%. The use of intraoperative rapid measurement of parathyroid hormone (PTH, IO-QPTH) as an assessment of completeness of resection of abnormal parathyroid tissue has been replaced by simply measuring PTH levels 30 minutes postoperatively, a technique that is more cost-effective, and which still allows same-day discharge whilst avoiding false-positive results with IO-QPTH. The introduction of MIP appears to be a factor in the increasing number of referrals for parathyroid surgery.