title: Outcomes for minimally invasive parathyroidectomy: widening inclusion criteria based on preoperative imaging results.
abstract: BACKGROUND
  Primary hyperparathyroidism is caused by a single adenoma in at least 80% of cases. Minimally invasive parathyroidectomy (MIP) has overtaken bilateral neck exploration as the gold standard for treatment in cases with adequate preoperative localization. There is evidence that, following careful review of preoperative imaging by the surgeon, increasing numbers of patients can successfully undergo MIP.
  
  
  METHODS
  We conducted a retrospective review of 225 consecutive cases performed by a single surgeon. Outcomes for patients with disease reported as localized by radiologists and nuclear medicine physicians using sestamibi and ultrasound were compared with patients with negative or indeterminate localization studies, in which the surgeon reviewed the sestamibi, performed an ultrasound study and identified likely single adenomas and planned MIP.
  
  
  RESULTS
  One hundred and sixty patients with radiologist-localized disease and an additional 29 patients with surgeon-localized disease underwent MIP. The surgeon-localized group had higher rates of conversion to bilateral neck exploration (21% compared with 4%, P = 0.004), but rates of failure to cure were comparable between the two groups (4.3% compared with 2.8%).
  
  
  CONCLUSIONS
  Careful review of preoperative sestamibi and ultrasound studies by an experienced surgeon can increase the number of patients that can successfully undergo MIP for the treatment of primary hyperparathyroidism. Offering MIP to these patients does not result in increased rates of failure or recurrence.
authors.affiliation: Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Reilly
authors.affiliation: Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Chew
authors.affiliation: Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Jazmin
authors.initials: J
authors.lastname: Eckhaus
authors.affiliation: Gippsland Medical School, Monash University, Churchill, Victoria, Australia.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.affiliation: Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Farrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: hyperparathyroidism; minimally invasive; parathyroid; parathyroidectomy; primary; sestamibi; surgical procedures