A simplified approach to minimally invasive parathyroidectomy

Area of Science:

• Endocrinology
• Surgical Oncology
• Clinical Chemistry

Background:

• Minimally invasive parathyroidectomy (MIP) relies on accurate intraoperative assessment.
• Established criteria for intraoperative parathyroid hormone (IOPTH) assays can be complex.
• A simplified IOPTH approach may improve efficiency and accuracy in MIP.

Purpose of the Study:

• To evaluate a simplified IOPTH assay using a single 10-minute post-excision level.
• To establish the workup parathyroid hormone level (wPTH) as a baseline for IOPTH assessment.
• To compare the predictive value of this simplified criterion with existing MIP criteria.

Main Methods:

• A retrospective case series of 102 patients undergoing MIP.
• Data collected from a prospectively maintained parathyroidectomy database.
• Analysis of IOPTH levels at 10 minutes post-excision against wPTH baseline.

Main Results:

• A ≥50% drop in IOPTH at 10 minutes post-excision showed high accuracy (97%).
• This simplified criterion yielded low false positive (1.9%) and false negative (0.9%) rates.
• Sensitivity (98.9%) and negative predictive value (83.3%) were notably high.

Conclusions:

• A single 10-minute post-excision IOPTH level with wPTH baseline is a feasible simplified criterion for MIP.
• This approach demonstrates comparable accuracy to the Miami and Vienna criteria.
• Further exploration of this simplified IOPTH method is warranted to avoid multiple sample collections.