[Surgical treatment of primary hyperparathyroidism: minimally invasive if possible, conventional neck exploration if necessary].
OBJECTIVE
To determine the results of surgical treatment of patients with primary hyperparathyroidism by means of a protocol consisting of preoperative imaging, perioperative parathormone (PTH) measurement, and a minimally invasive approach in the case of a solitary parathyroid adenoma being unequivocally identified and a conventional neck exploration in all other cases.


METHODS
Prospective and descriptive.


METHODS
A total of 100 consecutive patients with primary hyperparathyroidism underwent neck imaging (ultrasound, CT) according to a fixed protocol. When a solitary parathyroid adenoma could be unequivocally identified, patients underwent minimal invasive surgery. All other patients underwent a conventional systematic neck exploration. If during the minimally invasive approach the parathyroid adenoma could not be found or the PTH level did not exhibit a decrease of more than 50% perioperatively, the procedure was converted to a conventional neck exploration. A successful operation was defined as a persistent normocalcaemia.


RESULTS
In 74 patients preoperative imaging was performed with ultrasound and CT, in 20 patients only ultrasound was used, 4 patients underwent CT in combination with scintigraphy and 2 patients only CT. In 72 of the 100 patients a minimally invasive approach was carried out and for 6 of these the procedure was converted to a conventional neck exploration (in 4 patients the adenoma was not found, in 2 there was an insufficient decrease in PTH level). A primary conventional exploration was carried out in 28 patients. Normocalcaemia was achieved in 98 of the 100 patients. In 2 patients the hypercalcaemic state persisted (in one due to iatrogenic failure, in one due to a mediastinal adenoma).


CONCLUSIONS
The protocol presented had a 98% success rate. Therefore, a conventional neck exploration is no longer the procedure of first choice in the surgical treatment of primary hyperparathyroidism; in two thirds of cases a minimally invasive technique suffices.
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006934:Hypercalcemia; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D037981:Neck Dissection; D010281:Parathyroid Hormone / Q000032:analysis; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D010281:Parathyroid Hormone
Operatie voor primaire hyperparathyreoïdie: minimaal invasief indien mogelijk, conventionele halsexploratie indien noodzakelijk.