Hyperparathyroidism surgery On the Web
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Surgery is the mainstay of treatment for hyperparathyroidism. Symptomatic hyperparathyroidism is an indication for surgery. However, there are guidelines for surgery in asymptomatic primary hyperparathyroidism. Surgery for hyperparathyroidism is parathyroidectomy which includes bilateral neck exploration and minimally invasive parathyroidectomy. Most commonly done surgery for hyperparathyroidism is minimally invasive parathyroidectomy (MIP). There are various types of MIP. MIP provides excellent postoperative cure rates comparable to bilateral neck exploration (BNE) with less complications than BNE. This is due to precise preoperative localization of hyper-functioning parathyroid gland and use of intraoperative parathyroid hormone (IOPTH) monitoring for predicting post-surgical success (postoperative normocalcemia).
- Symptomatic hyperparathyroidism is an indication for surgery. However, there are guidelines for surgery in asymptomatic primary hyperparathyroidism.
|Guidelines for Surgery in Asymptomatic PHPT|
- Surgery is the mainstay of treatment for hyperparathyroidism.
Minimally invasive parathyroidectomy
- Most commonly done surgery for hyperparathyroidism is minimally invasive parathyroidectomy (MIP).
- MIP is may done in loco-regional anesthesia or general anesthesia.
- Various techniques for MIP includes:
- Open minimally-invasive parathyroidectomy (OMIP)
- Minimally-invasive radio-guided parathyroidectomy (MI-RP)
- Endoscopic parathyroidectomy (EP)
- Minimally invasive video-assisted parathyroidectomy (MIVAP)
- Video-assisted parathyroidectomy through a lateral approach (VAP-LA)
- Minimally-invasive radio-guided parathyroidectomy
- Open minimally-invasive parathyroidectomy (OMIP) is the most commonly used minimally invasive parathyroidectomy.
- MIP increases safety and cost-effectiveness in patients with preoperative localization of hyper-functioning parathyroid glands.
- Hyper-functioning parathyroid glands are excised and operative cure is confirmed by rapid intraoperative PTH assay.
- MIP provides excellent postoperative cure rates comparable to bilateral neck exploration. This is due to precise preoperative localization of hyper-functioning parathyroid gland and use of intraoperative parathyroid hormone (IOPTH) monitoring for predicting post-surgical success (postoperative normocalcemia).
Bilateral neck exploration
- Bilateral neck exploration (BNE) is the traditional surgery for hyperparathyroidism.
- BNE is usually done under general anesthesia.
- BNE is used less commonly as outcomes is comparable to MIP.
- MIP has similar success rate as BNE.
- Rate of complications is low in MIP compared to BNE.
- Operating time is reduced to almost half in MIP compared to BNE.
- Hospital stay is reduced by seven folds after MIP compared to BNE.
- MIP results in a mean cost savings of $2,693 per procedure compared to BNE accounting to approximately 50% reduction in total hospital charges.
- MIP has lower incidence of post-operative severe symptomatic hypocalcemia compared to BNE.
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