Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches.
OBJECTIVE
Minimally invasive parathyroidectomy (MIP) is generally performed under general anesthesia. This study evaluates the efficacy and safety of MIP performed under intravenous sedation with local anesthesia.


METHODS
Historical cohort study.


METHODS
One hundred eighty-six consecutive patients undergoing MIP using sedation with local anesthesia.


METHODS
Two different targeted approaches were used to achieve good exposure with minimal retraction, which allows the procedure to be performed with little discomfort. In all patients, an adenoma was localized preoperatively and its depth mapped by sestamibi scan with single-photon emission computed tomography and/or ultrasound. A midline anterior approach was used for inferior glands that were superficially located. A lateral approach was used for glands that were located posteriorly or superiorly.


RESULTS
MIP was successfully completed under local/sedation in 177 patients; 167 were discharged the same day. Complications include two pneumothorax, one small hematoma, and one transient vocal cord paralysis.


CONCLUSIONS
By using a targeted approach, MIP can be safely performed under local anesthesia in appropriately selected patients.
Shindo
Maisie L
ML
SUNY at Stony Brook, Stony Brook, NY 11794, USA. maisie.shindo@sunysb.edu
Rosenthal
Joshua M
JM
Lee
Thomas
T
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000772:Anesthesia, Local; D016292:Procedural Sedation; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi