Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism

Area of Science:

• Nephrology
• Endocrinology
• Surgical Anesthesiology

Background:

• Renal hyperparathyroidism and osteodystrophy are common, severe complications in patients undergoing long-term renal replacement therapy.
• A subset of these patients presents with significant cardiorespiratory dysfunction, posing extreme risk for general anaesthesia (GA).
• Local anaesthesia (LA) offers a potential alternative for surgical intervention in this high-risk population.

Purpose of the Study:

• To evaluate the safety and efficacy of total parathyroidectomy performed under local anaesthesia (LA).
• To assess the feasibility of LA for selected high-risk patients with severe cardiorespiratory dysfunction.
• To determine the operative outcomes and complication rates associated with LA parathyroidectomy.

Main Methods:

• A prospective study accrued 32 consecutive patients with severe cardiorespiratory dysfunction undergoing total parathyroidectomy under LA over 7 years.
• Patient characteristics, operative outcomes, and feasibility of LA were analyzed.
• Histopathological examination confirmed gland removal numbers.

Main Results:

• 50% of patients had severe restrictive lung disease, and 50% had poor cardiac status.
• Histopathology confirmed removal of 3 or 4 parathyroid glands in most patients; 2 patients with 2 glands removed experienced recurrent hypercalcemia.
• All patients reported symptomatic improvement, with minimal post-operative complications including wound hematoma and one case each of acute coronary syndrome and congestive heart failure.

Conclusions:

• Total parathyroidectomy can be safely and successfully performed under local anaesthesia (LA).
• LA is a suitable alternative to general anaesthesia (GA) for selected high-risk patients, mitigating anaesthetic risks.
• This approach improves quality of life for patients with end-stage renal failure and severe comorbidities.