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Focused parathyroidectomy without intra-operative parathyroid hormone monitoring for primary hyperparathyroidism: results in a low-volume hospital

Published online by Cambridge University Press:  15 June 2015

T-L Chow ,
C-Y Choi  and
S-H Lam
T-L Chow*
Affiliation:
Department of Surgery, United Christian Hospital, Kowloon, Hong Kong SAR
C-Y Choi
Affiliation:
Department of Surgery, United Christian Hospital, Kowloon, Hong Kong SAR
S-H Lam
Affiliation:
Department of Surgery, United Christian Hospital, Kowloon, Hong Kong SAR
*
Address for correspondence: Dr T-L Chow, Department of Surgery, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR Fax: 852 3513 5619 E-mail: [email protected]
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Abstract

Background:

The role of routine intra-operative parathyroid hormone monitoring for sporadic primary hyperparathyroidism is contentious. Satisfactory results can be achieved in high-volume centres. The results of low-volume hospitals are rarely studied.

Methods:

A retrospective, non-comparative study was conducted. From November 2002 to October 2012, 105 patients with clinically sporadic primary hyperparathyroidism underwent focused parathyroidectomy without intra-operative parathyroid hormone monitoring. Single adenoma was localised on pre-operative ultrasonography or sestamibi scan. The cure rate, surgical complication rate and pathology findings were evaluated.

Results:

Most of the operations (63.8 per cent) were performed under local anaesthesia. All but two patients (98.1 per cent) were cured after surgery. There was only one case of double adenomas. No recurrent hyperparathyroidism was observed after a mean follow up of 56.9 months. Surgical complications comprised two cases (1.9 per cent) of transient vocal fold palsy and one case (1.0 per cent) of permanent vocal fold palsy. Seven patients (6.7 per cent) suffered temporary hypocalcaemia.

Conclusion:

Satisfactory results of focused parathyroidectomy without routine intra-operative parathyroid hormone monitoring for appropriately selected primary hyperparathyroidism cases can be attained in a low-volume hospital.

Keywords

Intraoperative MonitoringParathyroid HormonePrimary HyperparathyroidismParathyroidectomyOutcome Study
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 8 , August 2015 , pp. 788 - 794
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Reeve, TS, Babidge, WJ, Parkyn, RF, Edis, AJ, Delbridge, LW, Devitt, PG et al. Minimally invasive surgery for primary hyperparathyroidism: a systematic review. Aust N Z J Surg 2011;70:244–50CrossRefGoogle Scholar
2Duh, QY. Presidential address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 2003;134:849–57CrossRefGoogle ScholarPubMed
3Bergenfelz, A, Kanngiesser, V, Zielke, A, Nies, C, Rothmund, M. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 2005;92:190–7CrossRefGoogle ScholarPubMed
4Stalberg, P, Sidhu, S, Sywak, M, Robinson, B, Wilkinson, M, Delbridge, L. Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: does it “value-add” to decision-making? J Am Coll Surg 2006;203:1–6CrossRefGoogle Scholar
5Denham, DW, Norman, J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely on the surgeon's choice of operative procedure. J Am Coll Surg 1998;186:293–304CrossRefGoogle ScholarPubMed
6Goldstein, RE, Blevins, L, Delbeke, D, Martin, WH. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg 2000;231:732–42CrossRefGoogle ScholarPubMed
7Miccoli, P, Bendinelli, C, Berti, P, Vignali, E, Pinchera, A, Marcocci, C. Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study. Surgery 1999;126:1117–22CrossRefGoogle ScholarPubMed
8Barczynski, M, Cichon, S, Konturek, A, Cichon, W. Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 2006;30:721–31CrossRefGoogle ScholarPubMed
9Brunaud, L, Zarnegar, R, Wada, N, Ituarte, P, Clark, OH, Quh, QY. Incisional length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 2003;138:1140–3CrossRefGoogle Scholar
10Shindo, ML, Rosenthal, JM, Lee, T. Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches. Otolaryngol Head Neck Surg 2008;138:381–7CrossRefGoogle ScholarPubMed
11Udelsman, R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665–70CrossRefGoogle ScholarPubMed
12Cohen, MS, Finkelstein, SE, Brunt, M, Haberfeld, E, Kangrga, I, Moley, JF et al. Outpatient minimally invasive parathyroidectomy using local/regional anesthesia: a safe and effective operative approach for selected patients. Surgery 2005;138:681–9CrossRefGoogle ScholarPubMed
13Stalberg, P, Delbridge, L, van Heerden, J, Barraclough, B. Minimally invasive parathyroidectomy and thyroidectomy--current concepts. Surgeon 2007;5:301–8CrossRefGoogle ScholarPubMed
14Harness, JK, Ramsburg, SR, Nishiyama, RH, Thompson, NW. Multiple adenomas of the parathyroids: do they exist? Arch Surg 1979;114:468–74CrossRefGoogle ScholarPubMed
15Haciyanli, M, Lai, G, Morita, E, Duh, QY, Kebebew, E, Clark, OH. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg 2003;197:739–46CrossRefGoogle ScholarPubMed
16Mazzeo, S, Caramella, D, Lencioni, R, Molea, N, De Liperia, A, Marcocci, C et al. Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. Am J Radiol 1996;166:1465–70Google ScholarPubMed
17Arici, C, Cheah, WK, Ituarte, PH, Mortia, E, Lynch, TC, Siperstein, AE et al. Can localization studies be used to direct focused parathyroid operation? Surgery 2001;129:720–9CrossRefGoogle Scholar
18Lo, CY, Lang, BH, Chan, WF, Kung, AW, Lam, KS. A prospective evaluation of preoperative localization by technetium-99m sestamibi and ultrasonography in primary hyperparathyroidism. Am J Surg 2007;193:155–9CrossRefGoogle ScholarPubMed
19Nussbaum, SR, Thompson, AR, Hutcheson, KA, Gaz, RD, Wang, CA. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery 1988;104:1121–7Google ScholarPubMed
20Irvin, GL 3rd, Prudhomme, DL, Deriso, GT, Sfakianakis, G, Chandarlapaty, SK. A new approach to parathyroidectomy. Ann Surg 1994;219:574–81CrossRefGoogle ScholarPubMed
21Bergenfelz, A, Isaksson, A, Lindblom, P, Westerdahl, J, Tibblin, S. Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery. Br J Surg 1998;85:1129–32CrossRefGoogle ScholarPubMed
22Chen, H, Mack, E, Starling, JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy. Which is most reliable? Ann Surg 2005;242:375–83CrossRefGoogle ScholarPubMed
23Carneiro-Pla, DM, Solorzano, CC, Irvin, GL 3rd. Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg 2006;202:715–22CrossRefGoogle ScholarPubMed
24Kandil, E, Alabbas, HH, Bansal, A, Islam, T, Tufaro, AP, Tufano, P. Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. Arch Otolaryngol Head Neck Surg 2009;135:1206–8CrossRefGoogle ScholarPubMed
25Agarwal, G, Barakate, MS, Robinson, B, Wilkinson, M, Barraclough, B, Reeve, TS et al. Intraoperative quick parathyroid hormone versus same-day parathyroid hormone testing for minimally invasive parathyroidectomy: a cost-effectiveness study. Surgery 2001;130:963–70CrossRefGoogle ScholarPubMed
26Jacobson, SR, van Heerden, JA, Farley, DR, Grant, CS, Thompson, GB, Mullan, BP et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 2004;28:1127–31CrossRefGoogle ScholarPubMed
27Mozzon, M, Mortier, PE, Jacob, PM, Soudan, B, Boersma, AA, Proye, CA. Surgical management of primary hyperparathyroidism. The case for giving up quick intraoperative PTH assay in favor of routine PTH measurement the morning after. Ann Surg 2004;240:949–54CrossRefGoogle ScholarPubMed
28Boudreaux, BA, Magnuson, JS, Asher, SA, Desmond, R, Peters, GE. The role of ultrasonography in parathyroid surgery. Arch Otolaryngol Head Neck Surg 2007;133:1240–4CrossRefGoogle ScholarPubMed
29Carling, T, Donovan, P, Rinder, C, Udelsman, R. Minimally invasive parathyroidectomy using cervical block. Reasons for conversion to general anesthesia. Arch Surg 2006;141:401–4CrossRefGoogle ScholarPubMed
30Shindo, ML, Rosenthal, JM. Minimal access parathyroidectomy using the focused lateral approach. Technique, indications, and results. Arch Otolaryngol Head Neck Surg 2007;133:1227–34CrossRefGoogle ScholarPubMed
31Suliburk, JW, Sywak, MS, Sidhu, SB, Delbridge, LW. 1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned. ANZ J Surg 2011;81:362–5CrossRefGoogle ScholarPubMed
32Haciyanli, M, Genc, H, Damburaci, N, Oruk, G, Tutuncuoglu, P, Erdogan, N. Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe. J Postgrad Med 2009;55:242–6CrossRefGoogle ScholarPubMed
33Lombardi, CP, Raffaelli, M, Traini, E, Di Stasio, E, Carrozza, C, De Crea, C et al. Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease. Langenbecks Arch Surg 2008;393:639–45CrossRefGoogle ScholarPubMed
34Riss, P, Scheuba, C, Asari, R, Bieglmayer, C, Niederle, B. Is minimally invasive parathyroidectomy without QPTH monitoring justified? Langenbecks Arch Surg 2009;394:875–80CrossRefGoogle ScholarPubMed
35Lew, JI, Rivera, M, Irvin, GL 3rd, Solorzano, CC. Operative failure in the era of focused parathyroidectomy. A contemporary series of 854 patients. Arch Surg 2010;145:628–33CrossRefGoogle Scholar
36Hwang, RS, Morris, LF, Ro, K, Park, S, Ituarte, PH, Hong, JC et al. A selective, Bayesian approach to intraoperative PTH monitoring. Ann Surg 2010;251:1122–6CrossRefGoogle ScholarPubMed
37Ozimek, A, Gallwas, J, Stocker, U, Mussack, T, Hallfeldt, KK, Ladurner, R. Validity and limits of intraoperative parathyroid hormone monitoring during minimally invasive parathyroidectomy: a 10-year experience. Surg Endosc 2010;24:3156–60CrossRefGoogle Scholar
38Udelsman, R, Lin, Z, Donovan, P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 2011;253:585–91CrossRefGoogle ScholarPubMed
39Mihai, R, Palazzo, FF, Gleeson, FV, Sadler, GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg 2007;94:42–7CrossRefGoogle ScholarPubMed
40Moure, D, Larranaga, E, Dominguez-Gadea, L, Luque-Ramirez, M, Nattero, L, Gomez-Pan, A et al. 99MTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration. Surgery 2008;144:454–9CrossRefGoogle ScholarPubMed
41Vaid, S, Pandelidis, S. Minimally invasive parathyroidectomy. A community hospital experience. Arch Surg 2011;146:876–8CrossRefGoogle ScholarPubMed
42Wong, W, Foo, FJ, Lau, MI, Sarin, A, Kiruparan, P. Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature. Ann R Coll Surg Engl 2011;93:290–3CrossRefGoogle ScholarPubMed
43Pang, T, Stalberg, P, Sidhu, S, Sywak, M, Wilkinson, M, Reeve, TS et al. Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring. Br J Surg 2007;94:315–19CrossRefGoogle ScholarPubMed
44Tan, P, Wilkinson, H, Levenson, SH. Limited role for intraoperative intact PTH measurement in parathyroid surgery. Ann R Coll Surg Engl 1995;77:28–30Google ScholarPubMed
45Kandil, E, Malazai, AJ, Alrasheedi, S, Tufano, RP. Minimally invasive/focused parathyroidectomy in patients with negative sestamibi scan results. Arch Otolaryngol Head Neck Surg 2012;138:223–5CrossRefGoogle ScholarPubMed
46Spanknebel, K, Chabot, JA, DiGiorgi, M, Cheung, K, Lee, S, Allendorf, J et al. Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg 2005;210:375–85CrossRefGoogle Scholar
47Tibblin, S, Bondeson, AG, Ljungberg, O. Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 1982;195:245–52CrossRefGoogle ScholarPubMed
48Bergenfelz, A, Lindblom, P, Tibblin, S, Westerdah, J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism--a prospective randomized controlled trial. Ann Surg 2002;236:543–51CrossRefGoogle Scholar
49Bhattacharyya, A, Buckler, HM, New, JP. Hungry bone syndrome revisited. J R Coll Physicians Edinb 2002;32:83–6Google Scholar
50Anzai, T, Yokoyama, J, Ohba, S, Ito, S, Fujimaki, M, Kojima, M et al. A case of severe hungry bone syndrome following parathyroidectomy analyzed with a focus on the alpha-Klotho calcium regulator. Head Neck Oncol 2012;4:57–61Google Scholar