title: Evaluation of the minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: A retrospective cohort study.
abstract: BACKGROUND
  An accurate differential diagnosis between single adenoma (SA) and multiglandular disease (MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive parathyroidectomy (MIP) in patients with PHPT.
  
  
  METHODS
  Clinical records of 48 patients who underwent neck exploration between November 2002 and June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that underwent for MIP which was defined as the selective removal of a SA using less invasive surgery.
  
  
  RESULTS
  The preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography, and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients in MIBI-negative group (n = 6) were MGD, who underwent neck exploration. Preoperative mean intact parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs. 277 U/l; P < 0.01) were significantly higher in the SA than MGD group.
  
  
  CONCLUSIONS
  In MIBI-negative patients with indications for surgery, MIP should not be carried out without a clear localization of SA, or in MGD.
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Sayoko
authors.initials: S
authors.lastname: Toriie
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Takeki
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Hokimoto
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Funakoshi
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Toyokazu
authors.initials: T
authors.lastname: Oki
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Dabanaka
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Genetic Medicine, Sapporo Medical University, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sakurai
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
keywords: Hypercalcemia; Minimally invasive parathyroidectomy (MIP); Primary hyperparathyroidism (PHPT); Tc-99m sestamibi scintigraphy