Minimally invasive parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe

Abstract

Objective: Minimal invasive parathyroidectomy (MIP) is a common surgical technique for the treatment of primary hyperparathyroidism (PHPT) and is usually done in conjunction with positive imaging techniques. We aimed to assess the results of this technique, performed without the use of intraoperative tests, in cases with PHPT caused by a single parathyroid adenoma.
Material and Methods: The data for patients who were diagnosed with PHPT were assessed retrospectively. Only those who had undergone a parathyroid adenoma localization study with ultrasonography (US) and parathyroid scintigraphy (PS) before the surgery, along with those patients for whom the MIP technique was routinely performed with frozen pathology, were included.
Results: The study group was made up of 65 patients who had undergone the MIP technique. The mean age of the patients was 56±14 (20-81), with most being females [M/F: 19 (29.2%)/46 (70.8%)]. The mean calcium values before the operation were 11.24±1.26 mg/dL (8-15.5) (normal range: 8.4-10.2), and the parathyroid hormone (PTH) values were 388 pg/mL (249-707.75). These same values, measured 24 hours after the operation, were determined as 9.04±1.04 mg/dL (6.8-13.9) and 27 pg/mL (6-86), respectively. The follow-up period for the patients was an average of 26.6±9.4 (3-76) months, and only 3 (4.6%) cases of persistent hyperparathyroidism were detected within this period.
Conclusion: Our success rate with MIP in PHPT cases was determined to be 95.4%; therefore, this technique may be applied with a high success rate without any assistance from intraoperative tests, such as rapid serum PTH (rPTH) assays or gamma probes, in the presence of localization results of PS and US.

Ethics committee approval was received for this study from the ethics committee of Adnan Menderes University Faculty of Medicine (B.30.2.ADÜ.0.20.05.00/050.040-120).

Due to the retrospective design of the study, the informed consent was not obtained.

Externally peer-reviewed.

Concept - A.S., M.Ü.; Design - A.S., M.Ü., S.Ö., E.G.; Supervision - S.Ö., E.G.; Funding - A.S., M.Ü.; Materials - A.S., M.Ü.; Data Collection and/or Processing - A.S., M.Ü.; Analysis and/or Interpretation - İ.K.Ö., S.Ö., E.G.; Literature Review - A.S., M.Ü.; Writer - A.S., M.Ü.; Critical Review - S.Ö., E.G., İ.K.Ö.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.