title: Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure.
abstract: BACKGROUND
  This study assessed the feasibility, efficacy and safety of focused parathyroidectomy combined with intraoperative parathyroid hormone (IOPTH) measurement in a day-case setting.
  
  
  METHODS
  Over 28 months 50 consecutive patients (mean age 63 (range 33-92) years) with clear evidence of unifocal disease on sestamibi scanning or ultrasonography underwent unilateral neck exploration via a small lateral incision. Blood samples for measurement of IOPTH were taken at induction of anaesthesia, before adenoma excision and after adenoma excision (at 5, 10 and 20 min). Ten patients were discharged within 23 h and 40 patients on the day of surgery.
  
  
  RESULTS
  A solitary adenoma was identified in all but one patient, with a mean operating time of 30 (range 16-57) min. After parathyroidectomy, IOPTH levels fell appropriately except in one patient with multiglandular hyperplasia. No patient developed symptomatic hypocalcaemia during the 2 weeks after operation, enabling cessation of oral supplements. All patients remained normocalcaemic on follow-up (mean 26 (range 8-84) weeks) and histological examination confirmed parathyroid adenoma (48 patients), hyperplasia (one) or carcinoma (one).
  
  
  CONCLUSIONS
  After accurate preoperative localization of uniglandular disease, patients with primary hyperparathyroidism may be managed successfully and safely by focused parathyroidectomy with IOPTH measurement as a day-case procedure.
authors.affiliation: Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Gurnell
authors.forename: S K
authors.initials: SK
authors.lastname: Thomas
authors.forename: I
authors.initials: I
authors.lastname: McFarlane
authors.forename: I
authors.initials: I
authors.lastname: Munday
authors.forename: K K
authors.initials: KK
authors.lastname: Balan
authors.forename: L
authors.initials: L
authors.lastname: Berman
authors.forename: V K K
authors.initials: VK
authors.lastname: Chatterjee
authors.forename: G C
authors.initials: GC
authors.lastname: Wishart
mesh_terms: D000236:Adenoma / Q000097:blood / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D005240:Feasibility Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*
chemical_list: D010281:Parathyroid Hormone