title: Open mini-incision parathyroidectomy for solitary parathyroid adenoma.
abstract: Parathyroid surgery is the acceptable definitive treatment for primary hyperparathyroidism (pHPT) due to parathyroid adenoma. Open mini-incision parathyroidectomy (O-MIP) has an excellent cure rate and minimal morbidity. We aim to demonstrate the safety, efficacy and subjective patient satisfaction of O-MIP and investigate the accuracy of pre-operative radiological localisation in relation to operative findings. A retrospective review of patients who underwent O-MIP for pHPT due to solitary parathyroid adenoma from April 2006 to August 2012 was performed. All patients were initially investigated by an endocrinologist to confirm pHPT with pre-operative localisation imaging using ultrasound scan (USS) and 99mTc-sestamibi (MIBI). One hundred and fifty consecutive patients were included with a median age of 62 years. Pre-operative USS and MIBI scans were concordant in 71 % of cases. In combined modality (USS and MIBI), localisation was 94.8 % accurate. There was 95.5 % identification of parathyroid tissue confirmed by intra-operative frozen section. Ninety-one percent of patients were treated as a day case. The median operative time was 60 min. The mean pre-operative calcium level was 2.98 mmol/l, and the short-to-medium term mean calcium level was 2.49 (Paired t test, p < 0.001). There was no significant complication. O-MIP confers significant advantages over the traditional gold standard treatment of bilateral neck exploration. Accurate localisation is the key to successful O-MIP. In experienced hands, ultrasound and MIBI may be the only pre-operative investigations required for accurate localisation.
authors: Doncaster Royal Infirmary, Doncaster, DN2 5LT, England, drckelly@hotmail.com.
authors: Ciaran W P
authors: CW
authors: Kelly
authors: Chee-Yean
authors: CY
authors: Eng
authors: M Shahed
authors: MS
authors: Quraishi
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D017060:Patient Satisfaction; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
references: N Engl J Med. 1980 Jan 24;302(4):189-93
references: 7350459
references: Lancet. 1980 Jun 21;1(8182):1317-20
references: 6104128
references: BMJ. 2009 Nov 20;339:b4613
references: 19933303
references: Otolaryngol Head Neck Surg. 2008 Mar;138(3):381-7
references: 18312889
references: World J Surg. 2011 Jan;35(1):140-6
references: 20886211
references: Surg Endosc. 2010 Dec;24(12):3156-60
references: 20490562
references: Arch Surg. 2002 Sep;137(9):1055-9
references: 12215160
references: World J Surg. 2004 Dec;28(12):1287-92
references: 15517474
references: Eur J Nucl Med. 1994 Jan;21(1):17-22
references: 8088281
references: Surg Clin North Am. 2004 Jun;84(3):717-34
references: 15145230
references: Int J Surg. 2012;10(7):373-7
references: 22691548
references: Endocr J. 2010;57(11):953-8
references: 20823623
references: Langenbecks Arch Surg. 2009 Sep;394(5):785-98
references: 19554347
references: Int J Clin Exp Med. 2012;5(1):80-6
references: 22328952
references: Radiol Med. 2009 Oct;114(7):1159-72
references: 19774444
references: Langenbecks Arch Surg. 2009 Sep;394(5):765-84
references: 19590890
references: J Clin Endocrinol Metab. 2009 Feb;94(2):366-72
references: 19193911
references: Arch Surg. 2005 May;140(5):472-8; discussion 478-9
references: 15897443
references: Ann Intern Med. 1997 Mar 15;126(6):433-40
references: 9072928
references: J Otolaryngol Head Neck Surg. 2010 Aug;39(4):361-9
references: 20643000
references: Ann Surg Oncol. 2011 Oct;18(10):2907-11
references: 21509629
references: Langenbecks Arch Surg. 2009 Sep;394(5):881-4
references: 19547996
references: Curr Probl Surg. 1997 Jun;34(6):445-523
references: 9186232
references: Langenbecks Arch Surg. 2009 Sep;394(5):799-809
references: 19590891
references: Clin Endocrinol (Oxf). 2008 Apr;68(4):520-8
references: 17973936
references: Arch Surg. 2009 Jul;144(7):643-8
references: 19620544
references: Ann Surg Oncol. 2007 Feb;14(2):744-9
references: 17122989
references: Acta Med Scand. 1974 Jun;195(6):473-7
references: 4835155
references: Head Neck. 2001 Feb;23(2):134-9
references: 11303630
references: J Am Coll Surg. 2008 Aug;207(2):246-9
references: 18656054