Parathyroid gland exploration with local anesthesia in elderly and high-risk patients

The management of symptomatic hyperparathyroidism in elderly and medically compromised patients, who are at risk under general anesthesia, may be safely and effectively accomplished using local anesthesia. Positive localization with ultrasound, thallium 201-technetium Tc 99m subtraction, and computed tomography permit surgical exploration with local anesthesia in one or two stages, or bilaterally in one stage, in selected cases, by employing the surgical lateral approach to parathyroid surgery. Our study of 29 patients selected for this technique affirms the value and the safety of this method, especially as surgical experience has grown and localization studies have improved. During the latter 24 months of our study, 11 (30%) of 36 operations were performed using local anesthesia by one of us. A success rate in ten of 11 cases was achieved, with one patient requiring a second exploration for adenomatous hyperplasia while under local anesthesia.