Parathyroidectomy in a district general hospital: outcomes and evolution in the era of minimally invasive surgery.
OBJECTIVE
To determine the outcomes of bilateral neck exploration (BNE) and uptake as well as outcomes of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism in a district general hospital (DGH).


METHODS
Patients who underwent first-time parathyroidectomy for primary hyperparathyroidism between August 1999 and December 2010 were identified from a prospectively maintained database of a single surgeon and were analysed for outcomes of MIP and BNE. MIP was adopted in 2006 and prior to that all patients underwent BNE. Results were analysed on an intention-to-treat basis.


RESULTS
A total of 368 patients underwent parathyroid surgery; BNE (n = 314) and MIP (n = 54). Overall cure rate was 97%. Intention-to-treat analysis, based on surgical approach, showed cure rates of 96.5% with BNE and 96.3% with MIP (p = 1.0). Of the 92 patients assessed for MIP, localisation by ultrasound and sestamibi were noted in 60 (65%) and 65 (71%) patients respectively; however, concordance between the scans was noted in only 54 (59%) patients. Of the 54 patients who underwent MIP, 5 (9.2%) were converted to BNE. Intention-to-treat analysis, based on preoperative imaging, showed cure rates of 96% with BNE and 98% with MIP (p = 0.53).


CONCLUSIONS
Satisfactory cure rates for parathyroidectomy are achievable in a 'medium-volume' endocrine unit within a DGH. Preoperative localisation studies with USS and MIBI have a positive concordance rate in only 60% of those considered for MIP, thereby limiting the use of MIP and reinforcing the role of BNE in this era of minimally invasive surgery.
Academic Vascular Unit, University of Sheffield, Sheffield S1 4DA, UK. sharathparavastu@gmail.com
S C V
SC
Paravastu
D R
DR
Chadwick
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome