[Targeted parathyroid surgery: a series of 100 consecutive patients].
BACKGROUND
The treatment of primary hyperparathyroidism has long required a bilateral neck exploration to localize all parathyroid glands. New techniques in pre-operative imaging (technetium-99m-sestamibi scanning, high resolution ultrasonography) have allowed an accurate localization of pathological glands. Moreover, the intraoperative intact parathyroid hormone assay (iPTH) now permits to confirm the resection of all hyper-secreting glands.


METHODS
Two hundred and twenty patients underwent parathyroid operations during the last 3 years, by different minimally invasive techniques. Pre- and intra-operative data, as well as the follow-up were recorded prospectively. The results of the last 100 unilateral approaches, performed for primary hyperparathyroidism, were analyzed.


RESULTS
There were 78 women and 22 men, with a mean age of 57 +/- 15 years (25 to 92 years). Mean operative time was 44 +/- 25 min. Ninety-three solitary adenomas, three double adenomas, three carcinomas and one hyperplasia were resected. Two patients required a bilateral exploration. There was one intra-operative complication (pneumothorax) during the resection of a mediastinal gland. Three post-operative complications occurred, with 2 hematomas and one transient recurrent laryngeal nerve paralysis. Median hospital stay was 2 +/- 7,5 hours (1-72 hours). All patients were cured following the operation, as predicted by the intra-operative iPTH assays.


CONCLUSIONS
These results suggest that unilateral, targeted, neck explorations offer a cure rate similar to those obtained by bilateral neck explorations. Moreover, this operation can be performed under local anesthesia, with a short hospital stay and recovery time. The morbidity rate is low but should be addressed by large-scale comparative studies.
Inabnet
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WB
Département de chirurgie, service de chirurgie laparoscopique : The Mount Sinai School of Medicine, New York, NY, USA. William.Inabnet@mountsinai.org
Biertho
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L
D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi