Minimally invasive parathyroidectomy in patients with previous endocrine surgery.
OBJECTIVE
Previous endocrine neck surgery (PENS) in patients with sporadic primary hyperparathyroidism (PHP) is considered a contraindication for minimally invasive parathyroidectomy (MIP). The purpose of our study was to determine the effectiveness of MIP in such patients.


METHODS
From January 2004 to December 2009, 270 patients with PHP were treated in our department; 30 had had PENS in the past. Eighteen were selected to have MIP, while the other 12 had traditional neck explorations. Selection criteria for MIP were unilateral single- or double-gland  disease localized preoperatively with at least 2 concordant imaging techniques and patient informed consent. Imaging studies included high-resolution neck ultrasound and sestamibi scan in most patients, and CT scan, selective venous sampling, and MRI in 7 patients. Unilateral explorations  via a lateral approach with the patients under local (UALA in 13 patients), general (MIP in 4 patients), or local followed by general anesthesia (1 patient) were performed.


RESULTS
Sixteen of the 17 patients became normocalcemic after the operation. There was no conversion to traditional  exploration. A single adenoma was found in 16 patients and hyperplasia in one. One patient underwent a successful parathyroidectomy 8 months later via mesothoracoscopy, because the parathyroid gland was localized correctly but was beyond access via neck. There were no postoperative complications.  Mean duration of the procedure and length of stay were similar to MIP in patients without PENS. Mean follow-up of 33 months (range, 4 to 70) did not reveal any recurrence.


CONCLUSIONS
These results illustrate that MIP is a valuable option in select patients with sporadic PHP and  PENS. Localization with 2 or more concordant imaging techniques could avoid intraoperative sestamibi or qPTH testing with low morbidity (0%), high biochemical cure rate (100% in this series), rapid recovery, and finally substantially lower the cost of the procedure.
Polykliniki, General Hospital, Department of Surgery, Athens, Greece.
Dimas
D
Spiros
Roukounakis
R
Nikolaos
Christakis
C
Ioannis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D013965:Thyroidectomy; D016896:Treatment Outcome