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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(MIP)
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(MIP)
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(MIP)
Parathyroid Surgery - Parathyroidectomy
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.
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Minimally invasive parathyroid surgery can be
accomplished through an incision measuring 1.5-2.0 cm in length.
(1.5-2.0 cm = 1/2-3/4 inch)
View
Larger Image | View Scar Gallery |
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Same patient (above
with penny) 3 months after surgery. Please mouse over the image to highlight scar. View
Larger Image | View Scar Gallery |
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MIP begins with a 1.5-2.0 cm skin incision
(1.5-2.0 cm = 1/2-3/4 inch).
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A parathyroid adenoma (yellow-tan colored) protrudes
into the surgical field during exposure for minimally invasive parathyroid surgery.
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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.
(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 |