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Minimal invasive parathyroidectomy with local anesthesia for well-localized primary hyperparathyroidism: "Cerrahpasa
Serkan Teksoz1, Yusuf Bukey, Murat Ozcan
1Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, 34098, Fatih/Istanbul, Turkey, serkanteksoz@gmail.com.
Abstract:
Imaging guided well-localized single gland excision via smaller incision without intraoperative parathormone (ioPTH) can be performed in ambulatory settings. Forty-six consecutive patients with solitary parathyroid adenoma causing primary hyperparathyroidism (PHPT), who underwent laterally approached minimal invasive parathyroidectomy (MIP) through 2-3 cm incision between January 2011 and April 2012, were included in the study. All data were collected prospectively; analyzed retrospectively. Intervention with local anesthesia was applied to 46 patients. Parathyroidectomy with local anesthesia and IV sedation was successfully completed in 42 of those. Forty-two patients had biochemically confirmed PHPT; single gland disease was supported by imaging methods. Localization was decided in 15 patients just with USG, in 11 patients just with scintigraphy, and in 16 patients with both. Preoperative mean serum total calcium value was 11.13 ± 1.02 mg/dl. Immediate postoperative and postoperative 2nd week's serum calcium levels were 10.62 ± 1.43 mg/dl (p = 0.006), 9.24 ± 0.79 mg/dl (p < 0.001), respectively. Preoperative mean serum PTH value was 434.17 ± 550.22 pg/ml. Immediate postoperative and postoperative 2nd week's PTH values were 34.69 ± 28.50 pg/ml (p < 0.001), 91.21 ± 81.86 pg/ml (p < 0.001), respectively. In all interventions, no ioPTH assay or frozen section was performed. Forty-one patients (97.62 %) had reduction of serum PTH levels equal or more than 50 %. Cure rate for short-term follow-up was also 97.62 %. One patient had persistent hypercalcemia. Mean operation time was 15:09 ± 6:38 min (range 5:30-35:00). For all excised parathyroid adenomas, average weight was 2,278 ± 1,653.01 mg (range 100-8,000). For patients with well-localized single gland disease, MIP with local anesthesia and IV sedation have high cure rates and less morbidity at experienced centers without general anesthesia and hospital stay.
