title: The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  To compare the results of minimally invasive parathyroidectomy (MIP) and conventional parathyroid surgery.
  
  
  BACKGROUND
  Primary hyperparathyroidism is a common endocrine disorder often treated by surgical intervention. Outpatient MIP, employing image-directed focused exploration under cervical block anesthesia, has replaced traditional surgical approaches for many patients with primary hyperparathyroidism. This retrospective review of a prospective database compared MIP with conventional parathyroid surgery.
  
  
  METHODS
  One thousand six hundred fifty consecutive patients underwent surgery for primary hyperparathyroidism by a single surgeon between 1990 and 2009 at 2 tertiary care academic hospitals. Conventional bilateral cervical exploration under general anesthesia was performed in 613 patients and MIP was performed in 1037 cases. Cure rates, complication rates, pathologic findings, length of hospital stay, and total hospital costs were compared.
  
  
  RESULTS
  Minimally invasive parathyroidectomy is associated with improvements in the cure rate (99.4%) and the complication rate (1.45%) compared to conventional exploration with a cure rate of 97.1% and a complication rate of 3.10%. In addition, the hospital length of stay and total hospital charges were also improved compared to conventional surgery.
  
  
  CONCLUSIONS
  Minimally invasive parathyroidectomy is a superior technique and should be adopted for the majority of patients with sporadic primary hyperparathyroidism.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06525, USA. Robert.udelsman@yale.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Udelsman
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Patricia
authors.initials: P
authors.lastname: Donovan
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics; D005260:Female; D017722:Hospital Charges; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D016105:Parathyroidectomy / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon