Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting

Area of Science:

• Endocrine Surgery
• Surgical Pathology

Background:

• Primary hyperparathyroidism is a common surgical endocrine condition.
• Parathyroid surgery has advanced with minimally invasive techniques.
• This study analyzes a long-term, single-center case series.

Purpose of the Study:

• To evaluate the effectiveness of intraoperative parathyroid hormone (ioPTH) monitoring in sporadic primary hyperparathyroidism surgery.
• To assess the impact of ioPTH use on surgical outcomes and efficiency.

Main Methods:

• Retrospective analysis of 504 patients with hyperparathyroidism treated between 2000 and 2020.
• Patients divided into groups based on the use of ioPTH.
• Comparison of surgical times, hospital stays, and outcomes between groups.

Main Results:

• Intraoperative parathyroid hormone (ioPTH) monitoring may be ineffective in primary parathyroidectomies, especially with concordant imaging.
• Not using ioPTH led to shorter operating times, anesthesia durations, and hospital stays.
• Reduced operating time allows for increased surgical volume and shorter patient waiting lists.

Conclusions:

• Minimally invasive parathyroidectomy offers a balance between invasiveness and aesthetics.
• Discontinuation of routine ioPTH use in select primary hyperparathyroidism cases can enhance surgical efficiency and patient recovery.
• The study highlights potential benefits of optimizing surgical protocols for endocrine surgery.