Parathyroidectomy - Minimally invasive (focused)

Anesthesia | Surgical Technique | Length of Operation | Surgeon-Performed Ultrasound
Intra-operative parathyroid hormone (IOPTH) monitoring | Duration of Hospitalization and Recovery

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Parathyroid Surgery - Parathyroidectomy

Background of Parathyroid Surgery

We receive many patient inquiries regarding minimally invasive parathyroidectomy (MIP). Conventional open (4-gland) parathyroid exploration was the considered the standard of care for treatment of primary hyperparathyroidism until the 1990s, when improvements in imaging techniques made limited (less than 4-gland) exploration feasible(1).

Now, many expert centers worldwide have adopted limited parathyroid exploration as their preferred surgical approach (2-4).

The underlying principle behind limited exploration is the fact that approximately 90% of individuals with primary hyperparathyroidism have only one diseased gland (5). The challenge is then to find the culprit gland successfully prior to operation. The essential imaging techniques used to localize solitary parathyroid adenomas are parathyroid sestamibi (a nuclear medicine test) and ultrasound.

In experienced hands, the sensitivity of each of these techniques approaches 90% (6, 7). Therefore, most people with primary hyperparathyroidism can be treated with MIP.

Definitions - Parathyroid Surgery

(See FAQ: What is the definition of minimally invasive parathyroidectomy?)

The movement toward MIP was initially driven by patients and market forces. Minimally invasive techniques, such as laparoscopy, were being used for abdominal operations, offering patients reduced pain and more rapid recovery. Similar approaches to endocrine surgery were seen as a logical extension of this. A number of novel techniques have been developed for limited parathyroid exploration:

• Videoendoscopic – gas insufflation
• Videoendoscopic – gasless
• Video-assisted (MIVAP)
• Radioguided/gamma probe (MIRP)
• Focused central mini-incision (2.5 cm = 1 in)
• Focused lateral mini-incision (1.5-2.0 cm = 0.6 to 0.8 in)

One significant problem affecting initial descriptions of these techniques was that many groups were calling their procedures “minimally invasive” without a clear definition of what exactly the term “minimally invasive” meant. In fact, this paucity of definitions remains a problem today, raising concern among some experts over the possibility that inflated claims are being used for the purpose of self-promotion (8).

The terminology problem was addressed in 2003 by Brunaud and associates from UC San Francisco, who systematically analyzed incision length for several types of endocrine operations. They recommended that the term “minimally invasive” only be applied to parathyroid procedures utilizing an incision length of less than 2.5 cm (1 in) (9). oParathyroid Surgery Minimly Invasive Parathyroidectomy (MIP) at UCLA i Dating x Fucking Tips fParathyroid Surgery Minimly Invasive Parathyroidectomy (MIP) at UCLA b Dating Online