Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism

Area of Science:

• Endocrine Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Primary hyperparathyroidism (pHPT) management is shifting towards minimally invasive techniques.
• Bilateral neck exploration is being superseded by targeted parathyroidectomy.
• Preoperative localization is key for successful minimally invasive parathyroidectomy.

Purpose of the Study:

• To evaluate the efficacy of minimal-access parathyroidectomy for primary hyperparathyroidism.
• To compare minimal-access surgery with bilateral neck exploration.
• To assess the role of preoperative localization and intraoperative parathyroid hormone monitoring.

Main Methods:

• Review of minimal-access parathyroidectomy techniques.
• Comparison with outcomes of bilateral neck exploration.
• Analysis of preoperative sestamibi and ultrasonography for localization.
• Evaluation of intraoperative parathyroid hormone (PTH) measurement utility.

Main Results:

• Minimal-access parathyroidectomy achieves comparable results to bilateral neck exploration with smaller incisions (<2.5 cm).
• Preoperative localization using sestamibi and ultrasonography is crucial for success.
• Minimal-access surgery allows for cure under local anesthesia, shorter hospital stays, and smaller incisions.
• Intraoperative PTH monitoring offers limited additional benefit when preoperative localization is optimized.

Conclusions:

• Minimal-access parathyroidectomy is a viable and advantageous surgical approach for primary hyperparathyroidism.
• Optimized preoperative localization enhances the success of minimally invasive techniques.
• Further controlled studies and long-term follow-up are needed to fully establish the value of minimal-access parathyroid surgery.