Lateral minimal parathyroidectomy: safety and cosmetic benefits.
BACKGROUND
Surgery has been the cornerstone of treatment for primary hyperparathyroidism for almost three decades. The recent application of state-of-the art imaging technologies to localize hyperfunctioning adenomas preoperatively has enabled surgeons to minimize the surgical procedure, reduce total operation time and improve cosmetic results without compromising the cure rate.


METHODS
Twenty-one patients with a diagnosis of primary hyperparathyroidism were selected for treatment with the lateral minimal parathyroidectomy approach following preoperative imaging with ultrasonography, Tc-sestamibi scan, or both. All patients were followed during hospitalization and for three months after for calcium levels and cosmetic results.


RESULTS
The procedure was performed by the same surgical team for all 21 patients; under general anesthesia in 20 patients and under deep sedation in 1 patient at high surgical risk. In all cases, parathyroid adenoma was accurately localized by at least one of the imaging modalities before surgery: ultrasonography in 16 patients (76%), Tc-sestamibi scan in 15 (71%), and both in 10 (48%). Average total operative time for the lateral minimal invasive approach was 46 minutes (range 30-65 minutes). Blood calcium levels returned to normal in all patients, and cosmetic results were graded good to excellent.


CONCLUSIONS
With accurate preoperative localization of unilateral parathyroid adenoma by any imaging modality and careful patient selection, lateral minimal parathyroidectomy performed by a skilled surgeon may serve as a safe, effective procedure with good clinical and aesthetic outcomes.
Koren
Ilan
I
Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tiqva, Israel. asaf890@bezeqint.net
Shpitzer
Thomas
T
Morgenshtern
Sara
S
Shvero
Jacob
J
D000236:Adenoma / Q000601:surgery* / Q000648:ultrastructure; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010282:Parathyroid Neoplasms / Q000601:surgery* / Q000648:ultrastructure; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D011300:Preoperative Care; D018570:Risk Assessment