Evaluation of the Consequences of Targeted or Focused Mini-Incision Parathyroidectomy in Patients With Primary Hyperparathyroidism
-
Hossein Hemmati
,
Yousha Pourahmadi
,
Behrang Motamed
,
Mohammad Taghi Ashoobi
,
Habib Eslami Kenarsari
Abstract
Surgical approaches to primary hyperparathyroidism (PHPT) have been associated with a change from invasive to non-invasive methods in the last 20 years. In this cross-sectional descriptive study, 55 patients with primary adenoma-induced HPT underwent surgery. The parathyroid gland in patients with primary hyperparathyroidism caused by parathyroid adenoma was removed by open surgery with an incision of about 2 cm in the neck in a targeted manner in a site localized by ultrasound or Sestamibi scan. The patients' personal information, including age, sex, length of hospital stay, serum calcium and parathyroid hormone (PTH) levels, success rate, and problems and unwanted adverse consequences of surgery (e.g. infection and bleeding) were recorded for each patient and collected information was analyzed in SPSS software. Most patients were women (80%) and individuals in the age range of 41-60 years (47.3%). The hospital stay length ranged from 2 to 5 days with an average of 3.25±0.9 days. Success was considered as a decrease in PTH and calcium levels during the first 24 h after the intervention, and success rates of 100, 98.2, and 69.1%, respectively, were evaluated for a reduction of at least 50% in PTH levels and less than 40 ng/ml of PTH levels. No major complications were reported in the studied patients. Wilcoxon test revealed significant decreases in patients' postoperative serum calcium and PTH levels (P=0.000). Mini-incision Parathyroidectomy with limited incision was associated with significant reductions in serum calcium and PTD without complications.
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3. Schwartz SI. Principles of surgery: Pretest self-assessment and review: McGraw-Hill, Health Professions Division; 1999.
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11. Duh Q-Y. Surgical approach to primary hyperparathyroidism (bilateral approach). Textbook of endocrine surgery Philadelphia. 1997:357-63.
12. Oertli D, Richter M, Kraenzlin M, Staub J, Oberholzer M, Haas HG, et al. Parathyroidectomy in primary hyperparathyroidism: preoperative localization and routine biopsy of unaltered glands are not necessary. Surgery. 1995;117(4):392-6.
13. Elliott DD, Monroe DP, Perrier ND. Parathyroid histopathology: is it of any value today? Journal of the American College of Surgeons. 2006;203(5):758-65.
14. Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel coronavirus pneumonia outbreak in 2019: computed tomographic findings in two cases. Korean journal of radiology. 2020;21(3):365.
15. Urkan M, Peker Y, Ozturk E. Minimally invasive parathyroidectomy for primary hyperparathyroidism. Acta Endocrinologica (Bucharest). 2019;15(2):182.
16. Ekici MF, Fatih K, Zeren S, Yildirim AC, Akdemir E, YAYLAK F, et al. Geriatrik Hastalarda Primer Hiperparatiroidi Tedavisinde Güvenli Yöntem: Minimal İnvazif Paratiroidektomi. Kafkas Tıp Bilimleri Dergisi.10(3):214-20.
17. Ishii H, Mihai R, Watkinson J, Kim D. Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy. BJS open. 2018;2(6):364-70.
18. Mancilla EE, Levine MA, Adzick NS. Outcomes of minimally invasive parathyroidectomy in pediatric patients with primary hyperparathyroidism owing to parathyroid adenoma: A single institution experience. Journal of Pediatric Surgery. 2017;52(1):188-91.
19. Thanyawat T, Tobias Carling. Minimally Invasive Parathyroidectomy. Minimally Invasive Parathyroidectomy. 14 Sep 2017;4:3.
20. Laird AM, Libutti SK. Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism. Surgical oncology clinics of North America. 2016;25(1):103-18.
21. Kurganov IA, Emel'yanov SI, Bogdanov DY, Matveyev NL, Lukyanchenko DV, Mamistvalov MS, et al. [The minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism]. Khirurgiia. 2017(7):33-9.
22. Gramática L, Cecenarro RR, Antueno FJ, Villablanca NS. [Primary Hyperthyroidism. Minimally invasive video-assisted parathyroidectomy]. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina). 2017;74(4):361-4.
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24. Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. The British journal of surgery. 2007;94(1):42-7.
25. Yang Z, Guo M, Wu B, Zheng Q, Fan Y. Focused parathyroidectomy through an open‐lateral approach for treating solitary parathyroid adenoma. Surgical Practice. 2015;19(4):160-5.
26. Adil E, Adil T, Fedok F, Kauffman G, Goldenberg D. Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism. Otolaryngology—Head and Neck Surgery. 2009;141(1):34-8.
27. Krausz MM, Ish-Shalom S, Ofer A. [Minimally invasive parathyroidectomy for treatment of primary hyperparathyroidism caused by parathyroid adenoma]. Harefuah. 2010;149(6):353-6, 404.
28. Shindo ML, Rosenthal JM, Lee T. Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches. Otolaryngology—Head and Neck Surgery. 2008;138(3):381-7.
29. Rubello D, Mariani G, Pelizzo M. Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients. Nuklearmedizin. 2007;46(03):85-92.
30. H. Lindekleiv JD, L. Thuy, T. A. Hansen, and P. Nilsen. “Minimally invasive treatment of primary hyperparathyroidism,” Tidsskrift for den Norske Laegeforening. 2007;127(9):1204–6.
31. S. Aarum JN, E. Reihnér et al. Operation for primary hyperparathyroidism: the new versus the old order: a randomised controlled trial of preoperative localisation. Scandinavian Journal of Surgery. 2007;96(1):26–30.
32. D. Politz CDL, B. Victor, R. Askew, and L. Jones. Minimally invasive radio-guided parathyroidectomy in 152 consecutive patients with primary hyperparathyroidism. Endocrine Practice. 2006;12(9):630–4.
33. T. Pang PS, S. Sidhu et al., . Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring. British Journal of Surgery. 2007;94(9):315–9.
34. A. S. Caudle SEB, B. F. Calvo, J. K. Hong, M. O. Meyers, and D. W. Ollila. Experienced radio-guided surgery teams can successfully perform minimally invasive radio-guided parathyroidectomy without intraoperative parathyroid hormone assays. American Surgeon. 2006;72(9):785–9.
35. A. Alfadda AH, K. Al-Qahtani, and R. Tabah. “Radio-guided minimally invasive parathyroidectomy under local anesthesia,” West African Journal of Medicine. 2006;25(2):134–7.
2. Colaço SM, Si M, Reiff E, Clark OH. Hyperparathyroidism after radioactive iodine therapy. The American journal of surgery. 2007;194(3):323-7.
3. Schwartz SI. Principles of surgery: Pretest self-assessment and review: McGraw-Hill, Health Professions Division; 1999.
4. Sai Prasad T, Bhatnagar V. Giant solitary parathyroid adenoma presenting with bone disease. Indian pediatrics. 2002;39(11):1044-7.
5. Emmelot-Vonk M, Samson M, Raymakers J. Cognitive deterioration in elderly due to primary hyperparathyroidism--resolved by parathyroidectomy. Nederlands tijdschrift voor geneeskunde. 2001;145(41):1961-4.
6. Dieter Jr RA, O'Brien T, Carpenter R. Giant mediastinal parathyroid adenoma with hypercalcemia. International surgery. 2002;87(4):217-20.
7. Thompson DF. Understanding financial conflicts of interest. New England journal of medicine. 1993;329:573-.
8. Bellantone R, Raffaelli M, De Crea C, Traini E, Lombardi CP. Minimally-invasive parathyroid surgery. Acta Otorhinolaryngologica Italica. 2011;31(4):207.
9. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Annals of surgical oncology. 2012;19(2):577-83.
10. Conrad DN, Olson JE, Hartwig HM, Mack E, Chen H. A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay. Journal of Surgical Research. 2006;133(1):38-41.
11. Duh Q-Y. Surgical approach to primary hyperparathyroidism (bilateral approach). Textbook of endocrine surgery Philadelphia. 1997:357-63.
12. Oertli D, Richter M, Kraenzlin M, Staub J, Oberholzer M, Haas HG, et al. Parathyroidectomy in primary hyperparathyroidism: preoperative localization and routine biopsy of unaltered glands are not necessary. Surgery. 1995;117(4):392-6.
13. Elliott DD, Monroe DP, Perrier ND. Parathyroid histopathology: is it of any value today? Journal of the American College of Surgeons. 2006;203(5):758-65.
14. Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel coronavirus pneumonia outbreak in 2019: computed tomographic findings in two cases. Korean journal of radiology. 2020;21(3):365.
15. Urkan M, Peker Y, Ozturk E. Minimally invasive parathyroidectomy for primary hyperparathyroidism. Acta Endocrinologica (Bucharest). 2019;15(2):182.
16. Ekici MF, Fatih K, Zeren S, Yildirim AC, Akdemir E, YAYLAK F, et al. Geriatrik Hastalarda Primer Hiperparatiroidi Tedavisinde Güvenli Yöntem: Minimal İnvazif Paratiroidektomi. Kafkas Tıp Bilimleri Dergisi.10(3):214-20.
17. Ishii H, Mihai R, Watkinson J, Kim D. Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy. BJS open. 2018;2(6):364-70.
18. Mancilla EE, Levine MA, Adzick NS. Outcomes of minimally invasive parathyroidectomy in pediatric patients with primary hyperparathyroidism owing to parathyroid adenoma: A single institution experience. Journal of Pediatric Surgery. 2017;52(1):188-91.
19. Thanyawat T, Tobias Carling. Minimally Invasive Parathyroidectomy. Minimally Invasive Parathyroidectomy. 14 Sep 2017;4:3.
20. Laird AM, Libutti SK. Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism. Surgical oncology clinics of North America. 2016;25(1):103-18.
21. Kurganov IA, Emel'yanov SI, Bogdanov DY, Matveyev NL, Lukyanchenko DV, Mamistvalov MS, et al. [The minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism]. Khirurgiia. 2017(7):33-9.
22. Gramática L, Cecenarro RR, Antueno FJ, Villablanca NS. [Primary Hyperthyroidism. Minimally invasive video-assisted parathyroidectomy]. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina). 2017;74(4):361-4.
23. Barczynski M, Konturek A, Cichon S, Hubalewska-Dydejczyk A, Golkowski F, Huszno B. Intraoperative parathyroid hormone assay improves outcomes of minimally invasive parathyroidectomy mainly in patients with a presumed solitary parathyroid adenoma and missing concordance of preoperative imaging. Clinical endocrinology. 2007;66(6):878-85.
24. Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. The British journal of surgery. 2007;94(1):42-7.
25. Yang Z, Guo M, Wu B, Zheng Q, Fan Y. Focused parathyroidectomy through an open‐lateral approach for treating solitary parathyroid adenoma. Surgical Practice. 2015;19(4):160-5.
26. Adil E, Adil T, Fedok F, Kauffman G, Goldenberg D. Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism. Otolaryngology—Head and Neck Surgery. 2009;141(1):34-8.
27. Krausz MM, Ish-Shalom S, Ofer A. [Minimally invasive parathyroidectomy for treatment of primary hyperparathyroidism caused by parathyroid adenoma]. Harefuah. 2010;149(6):353-6, 404.
28. Shindo ML, Rosenthal JM, Lee T. Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches. Otolaryngology—Head and Neck Surgery. 2008;138(3):381-7.
29. Rubello D, Mariani G, Pelizzo M. Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients. Nuklearmedizin. 2007;46(03):85-92.
30. H. Lindekleiv JD, L. Thuy, T. A. Hansen, and P. Nilsen. “Minimally invasive treatment of primary hyperparathyroidism,” Tidsskrift for den Norske Laegeforening. 2007;127(9):1204–6.
31. S. Aarum JN, E. Reihnér et al. Operation for primary hyperparathyroidism: the new versus the old order: a randomised controlled trial of preoperative localisation. Scandinavian Journal of Surgery. 2007;96(1):26–30.
32. D. Politz CDL, B. Victor, R. Askew, and L. Jones. Minimally invasive radio-guided parathyroidectomy in 152 consecutive patients with primary hyperparathyroidism. Endocrine Practice. 2006;12(9):630–4.
33. T. Pang PS, S. Sidhu et al., . Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring. British Journal of Surgery. 2007;94(9):315–9.
34. A. S. Caudle SEB, B. F. Calvo, J. K. Hong, M. O. Meyers, and D. W. Ollila. Experienced radio-guided surgery teams can successfully perform minimally invasive radio-guided parathyroidectomy without intraoperative parathyroid hormone assays. American Surgeon. 2006;72(9):785–9.
35. A. Alfadda AH, K. Al-Qahtani, and R. Tabah. “Radio-guided minimally invasive parathyroidectomy under local anesthesia,” West African Journal of Medicine. 2006;25(2):134–7.
| Files | ||
| Issue | Vol 60 No 12 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i12.11826 | |
| Keywords | ||
| Parathyroidectomy Minimally invasive surgery Hyperparathyroidism Success Complications | ||
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How to Cite
1.
Hemmati H, Pourahmadi Y, Motamed B, Taghi Ashoobi M, Eslami Kenarsari H. Evaluation of the Consequences of Targeted or Focused Mini-Incision Parathyroidectomy in Patients With Primary Hyperparathyroidism. Acta Med Iran. 2023;60(12):742-748.
