Minimally invasive video-assisted parathyroidectomy without intraoperative parathyroid hormone monitoring

Abstract

Introduction and objectives: surgical treatment of primary hyperparathyroidism has evolved from the classical bilateral neck exploration to minimally invasive techniques due to recent advances in preoperative localisation methods. The additional value of intraoperative parathyroid hormone (PTH) monitoring is questioned. The aim of this study was to analyse the results of minimally invasive video-assisted parathyroidectomy (MIVAP) without intraoperative PTH monitoring.

Methods: the patients who underwent MIVAP without PTH monitoring for primary hyperparathyroidism between 2007 and 2013 were evaluated. In all cases the suspected enlarged gland was identified preoperatively by 99Tc-sestamibi scintigraphy, ultrasound or computed tomography.

Results: 71 patients were studied (56 females and 15 males), with a mean age of 60 years. In 3 cases (4%) the technique was converted to open parathyroidectomy. Calcium and PTH levels were normalised after first surgery in 69 cases (97%), and after a second surgery in the remaining 2 cases (a second contralateral and a second intrathyroid adenoma). One patient developed a postoperative wound infection, 1 postoperative hypocalcaemia, and 4 transient vocal fold paralysis. No permanent vocal fold paralysis or other complications were observed.

Conclusions: MIVAP is a safe, effective surgical technique to cure primary hyperparathyroidism. Intraoperative PTH monitoring may not be routinely necessary in patients treated with this technique.

Keywords: Cirugía; Hiperparatiroidismo primario; Hormona paratiroidea intraoperatoria; Intraoperative parathyroid hormone; Primary hyperparathyroidism; Surgery; Video-assisted; Videoasistida.