title: Minimally invasive parathyroidectomy: an audit of a change in clinical practice.
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is gaining acceptance as a useful tool in the armamentarium of the endocrine surgeon.
  
  
  METHODS
  We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach.
  
  
  RESULTS
  Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation.
  
  
  CONCLUSIONS
  Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.
authors.affiliation: Department of General Surgery, Base Hospital, Royal Perth Hospital, Perth, Western Australia, Australia. chinney@binternet.com.au
authors.forename: Ming K
authors.initials: MK
authors.lastname: Yew
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000592:standards; D011364:Professional Practice; D011877:Radionuclide Imaging; D012086:Reoperation; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi