Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism

Renal hyperparathyroidism with attendant osteodystrophy is a frequent and severe morbidity affecting the quality of life of end stage renal failure patients surviving on long-term renal replacement therapy. A small subgroup of these patients with severe cardiorespiratory dysfunction was deemed at very high risk for general anaesthesia (GA). We report on a series of total parathyroidectomy under local anaesthesia (LA) for these patients.

A total of 32 consecutive patients with severe cardiorespiratory dysfunction who underwent total parathyroidectomy under LA over a period of 7 years were prospectively accrued in this study. The patient characteristics, the operative outcome and the feasibility to surgery under LA were analysed.

Sixteen of the patients (50%) had severe restrictive lung disease as a result of renal osteodystrophy and the other 16 patients had poor cardiac status. Histopathological examination confirmed 23 (71.9%) patients had four glands removed and seven (21.9%) patients had three glands removed. Two patients had only two glands removed and had recurrent hypercalcaemia. However, all patients reported symptomatic improvement. The post-operative complications were minimal; one patient had acute coronary syndrome and wound haematoma and another patient had wound haematoma which necessitated exploration under LA. A further patient developed congestive heart failure requiring treatment in the coronary care unit.

Total parathyroidectomy can be performed safely and successfully under LA. We believe surgery under LA would be the most appropriate option for selected, high-risk patients to minimise the risk of GA.