One hundred consecutive minimally invasive parathyroid explorations.
OBJECTIVE
To review the outcomes of 100 consecutive minimally invasive parathyroid explorations.


BACKGROUND
Minimally invasive parathyroidectomy (MIP) has challenged the traditional approach of bilateral neck exploration for patients with primary hyperparathyroidism. Most patients with primary hyperparathyroidism have a single adenoma that when resected results in cure. It therefore appears logical to perform a directed approach to adenoma extirpation. MIP involves high-quality sestamibi images obtained with single photon emission computed tomography to localize enlarged parathyroid glands in three dimensions, limited exploration after surgeon-administered cervical block anesthesia, rapid intraoperative parathyroid hormone assay to confirm the adequacy of resection, and discharge within 1 to 3 hours of surgery.


METHODS
MIP was offered to 100 selected consecutive patients during an 18-month period beginning in March 1998.


RESULTS
Ninety-two cases were accomplished under cervical block anesthesia and 89 of these on an ambulatory basis. The cure rate was 100%, and there were no long-term complications. The mean hospital charge for MIP was less than 40% of that associated with traditional exploration.


CONCLUSIONS
Outpatient MIP appears to be the procedure of choice for most patients with primary hyperparathyroidism.
Udelsman
R
R
Departments of Surgery and Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. rudelsma@jhmi.edu
Donovan
P I
PI
Sokoll
L J
LJ
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000556:Ambulatory Surgical Procedures; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi