title: Safety and efficacy of minimally-invasive parathyroidectomy (MIP) under local anaesthesia without intra-operative PTH measurement.
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) is the choice of treatment in patients with sporadic adenomas localized on preoperative imaging. Currently there is no centre in the UK which performs this procedure under local anaesthesia. The aim of this study was to assess the efficacy and safety of MIP under local anaesthesia in patients with sporadic primary hyperparathyroidism (pHPT).
  
  
  METHODS
  This is a prospective, nonrandomized study of 86 patients with pHPT localized with Tc99m Sestamibi scan and ultrasound. MIPs were performed under local anaesthesia and sedation at the Oxford University Hospitals. Serum Ca and PTH were measured before discharge, at 6 weeks follow up, and at 6 months. Main outcome measures were cure at 6 months, complications with the procedure and operative time.
  
  
  RESULTS
  86 patients (58 females: 28 males) with a mean age of 65 (range 24-87) underwent MIP under local anaesthesia and sedation. All patients (100%) were normocalcaemic at 6 months following surgery. There was no incidence of temporary or permanent recurrent laryngeal nerve palsy or persistent hypercalcaemia. Two patients had temporary hypocalcaemia that resolved in 6 weeks. In one patient the neck incision needed extension for bleeding, with no incidence of wound haematoma or infection.
  
  
  CONCLUSIONS
  This study demonstrates that MIP (without ioPTH) can be safely performed under local anaesthesia for patients with sporadic primary hyperparathyroidism.
authors: Department of Endocrine Surgery, Oxford University Hospitals, Headington, Oxford OX3 9DU, UK.
authors: Parameswaran
authors: P
authors: Rajeev
authors: Michael J
authors: MJ
authors: Stechman
authors: Hilary
authors: H
authors: Kirk
authors: Fergus V
authors: FV
authors: Gleeson
authors: Radu
authors: R
authors: Mihai
authors: Gregory P
authors: GP
authors: Sadler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D008991:Monitoring, Physiologic; D061646:Operative Time; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging
chemical_list: D010281:Parathyroid Hormone