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MINIMALLY INVASIVE PARATHYROIDECTOMY: AN AUDIT OF A CHANGE IN CLINICAL PRACTICE
Author(s) -
Yew Ming K.,
Thompson Ivan J.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2006.03755.x
Subject(s) - medicine , parathyroidectomy , primary hyperparathyroidism , cure rate , audit , surgery , general surgery , invasive surgery , hyperparathyroidism , parathyroid hormone , management , economics , calcium
Background: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is gaining acceptance as a useful tool in the armamentarium of the endocrine surgeon. Methods: We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach. Results: Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation. Conclusion: Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.