[Surgical treatment of primary hyperparathyroidism: minimally invasive if possible, conventional neck exploration if necessary]

Ned Tijdschr Geneeskd. 2002 Sep 14;146(37):1735-9.
[Article in Dutch]

Abstract

Objective: To determine the results of surgical treatment of patients with primary hyperparathyroidism by means of a protocol consisting of preoperative imaging, perioperative parathormone (PTH) measurement, and a minimally invasive approach in the case of a solitary parathyroid adenoma being unequivocally identified and a conventional neck exploration in all other cases.

Design: Prospective and descriptive.

Methods: A total of 100 consecutive patients with primary hyperparathyroidism underwent neck imaging (ultrasound, CT) according to a fixed protocol. When a solitary parathyroid adenoma could be unequivocally identified, patients underwent minimal invasive surgery. All other patients underwent a conventional systematic neck exploration. If during the minimally invasive approach the parathyroid adenoma could not be found or the PTH level did not exhibit a decrease of more than 50% perioperatively, the procedure was converted to a conventional neck exploration. A successful operation was defined as a persistent normocalcaemia.

Results: In 74 patients preoperative imaging was performed with ultrasound and CT, in 20 patients only ultrasound was used, 4 patients underwent CT in combination with scintigraphy and 2 patients only CT. In 72 of the 100 patients a minimally invasive approach was carried out and for 6 of these the procedure was converted to a conventional neck exploration (in 4 patients the adenoma was not found, in 2 there was an insufficient decrease in PTH level). A primary conventional exploration was carried out in 28 patients. Normocalcaemia was achieved in 98 of the 100 patients. In 2 patients the hypercalcaemic state persisted (in one due to iatrogenic failure, in one due to a mediastinal adenoma).

Conclusion: The protocol presented had a 98% success rate. Therefore, a conventional neck exploration is no longer the procedure of first choice in the surgical treatment of primary hyperparathyroidism; in two thirds of cases a minimally invasive technique suffices.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnostic imaging
  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Hypercalcemia
  • Hyperparathyroidism / diagnostic imaging
  • Hyperparathyroidism / surgery*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Neck Dissection
  • Parathyroid Hormone / analysis
  • Parathyroid Neoplasms / diagnostic imaging
  • Parathyroid Neoplasms / surgery*
  • Parathyroidectomy
  • Prospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography

Substances

  • Parathyroid Hormone