Three new tools for parathyroid surgery: expensive and unnecessary?
BACKGROUND
The intraoperative quick parathyroid hormone assay, the intraoperative gamma probe, and endoscopic parathyroidectomy are three very new techniques developed to facilitate parathyroid surgery. Some hospitals do not have the necessary equipment, and many, like ours, continue to operate in the time-honored way.


METHODS
We performed a retrospective chart review of 34 such operations, done with the use of Sestamibi scans, but entirely without the newer modalities.


RESULTS
Four-gland exploration was carried out on all patients. Operative times ranged from 15 to 165 minutes, with a mean of 47 minutes, and incision lengths ranged from 2 to 3 cm, with a mean of 2.8 cm. There was no mortality, no reoperation, and no vocal cord or recurrent laryngeal nerve injury. Our cure rate was 100%, as determined by a fall in postoperative calcium and parathormone levels.


CONCLUSIONS
In our view, the intraoperative parathyroid hormone assay, gamma probe, and endoscopic parathyroidectomy add an entirely unnecessary cost to an operation that can be completed satisfactorily with a preoperative Sestamibi scan and a thorough four-gland exploration.
Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA.
George
G
Ferzli
Samir
S
Patel
Andre
A
Graham
Kenneth
K
Shapiro
Hung-Kei
HK
Li
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics; D005260:Female; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D006961:Hyperparathyroidism / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000191:economics* / Q000295:instrumentation*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000295:instrumentation; D013673:Technology Assessment, Biomedical; D013675:Technology, High-Cost / Q000191:economics*
D010281:Parathyroid Hormone; D002118:Calcium