title: Rapid intraoperative determination of intact parathyroid hormone during surgery for primary hyperparathyroidism. Experience at our center.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT.
  
  
  METHODS
  Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012.
  
  
  RESULTS
  In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients.
  
  
  CONCLUSIONS
  Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: esther_garcia_santos@hotmail.com.
authors.forename: Esther Pilar
authors.initials: EP
authors.lastname: García-Santos
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín-Fernández
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Aurora
authors.initials: A
authors.lastname: Gil-Rendo
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Bruno
authors.initials: B
authors.lastname: Menchén-Trujillo
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez de Paz
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Manzanares-Campillo
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: Muñoz-Atienza
authors.affiliation: Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Susana
authors.initials: S
authors.lastname: Sánchez-García
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000209:etiology / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone
keywords: Ambulatory surgery; Cirugía mayor ambulatoria; Cirugía mínimamente invasiva; Hiperparatiroidismo primario; Intact parathyroid hormone; Minimally invasive surgery; Paratirina intacta; Primary hyperparathyroidism