title: Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring.
abstract: BACKGROUND
  Reoperative parathyroidectomy (R-PTX) in primary hyperparathyroidism (1HPT) has increased failure rates and morbidity. This study evaluated R-PTX during the era of minimal-access PTX with intraoperative parathyroid hormone (IOPTH) monitoring.
  
  
  METHODS
  Two thousand sixty-five patients with 1HPT who underwent PTX were assessed for R-PTX. Preoperative studies, operative findings, and outcomes were evaluated.
  
  
  RESULTS
  Two hundred twenty-eight patients underwent 236 R-PTX procedures. Imaging performed included sestamibi (89%), ultrasound (US; 56%), computed axial tomography/magnetic resonance imaging (5%), and selective venous sampling (1%). Sestamibi was more sensitive than US (84% vs 68%). Curative surgery was performed in 89% of patients. IOPTH was 99% sensitive. There was no relationship between cure and the following parameters: preoperative calcium or PTH levels, persistent or recurrent disease, or use of IOPTH. Solitary gland disease and a single previous operation were associated with increased likelihood of cure (P = .06). Hypoparathyroidism was decreased using IOPTH monitoring (2% vs 9%). One patient had recurrent laryngeal nerve palsy.
  
  
  CONCLUSIONS
  R-PTX can be performed effectively with minimal complications. IOPTH is an accurate predictor of cure and may decrease the frequency of permanent hypoparathyroidism.
authors.affiliation: Mayo Clinic, Department of Surgery, Rochester, MN, USA. richards.melanie@mayo.edu
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Richards
authors.forename: Geoff B
authors.initials: GB
authors.lastname: Thompson
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone