Minimally invasive parathyroid surgery

Minimally invasive parathyroidectomy offers patients a less morbid surgical approach to treat primary hyperparathyroidism. Biochemically diagnosed hyperparathyroid patients undergo a preoperative sestamibi scan to localize abnormal parathyroid tissue. If the scan is positive, a focused unilateral neck exploration is performed through a 2-3 cm incision with the aid of a gamma detector to identify the radioactive, abnormal parathyroid gland(s).In the Ochsner Clinic's initial experience with minimally invasive parathyroidectomy, 34 patients were evaluated with 20 positive scans, 4 suggestive scans, and 10 negative scans. Of the 24 patients with scans demonstrating abnormal parathyroid activity, 23 were successfully managed with the minimally invasive technique. The mean total surgical time was 72.9 minutes, and the mean weight of the excised parathyroid glands was 1445.4 mg. All 10 patients with negative scans had a traditional bilateral neck exploration lasting a mean time of 146.5 minutes; the mean weight of the excised parathyroid glands was 388.6 mg. Hypercalcemia was cured in all 24 patients in the positive group and 9 of 10 patients in the negative scan group.Ochsner's initial experience with minimally invasive parathyroidectomy demonstrates that about 70% of patients can expect to be candidates for this technique, which is associated with excellent cure rates and shorter operative times.