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*10 YEAR HISTORY OF OVER 1000 CONSECUTIVE MINIMALLY INVASIVE PARATHYROIDECTOMIES (MIPS) WITHOUT INTRAOPERATIVE PTH AT A SINGLE INSTITUTION: LESSONS LEARNED
Author(s) -
Suliburk J. W.,
Sywak M. S.,
Sidhu S. B.,
Delbridge L. W.
Publication year - 2009
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.1445-2197.2009.04916_11.x
Subject(s) - medicine , primary hyperparathyroidism , parathyroidectomy , surgery , parathyroid neoplasm , parathyroid hormone , general surgery , parathyroid adenoma , calcium
Purpose: Minimally invasive parathyroidectomy (MIP) has become the procedure of choice to treat primary hyperparathyroidism. The role for intra‐operative parathyroid hormone measurement (IOPTH) is controversial. Some experts indicate that IOPTH is a requirement for MIP while others feel it not needed. We reviewed a 10 year history of MIP at a single institution without use of IOPTH to determine reasons for failure. Methodology: This study is a retrospective review of the University of Sydney Endocrine Surgery Database from May of 1998 to August of 2008. The database was queried for MIPs performed as well as for failed operations. Patient record analysis was completed to determine the reason for failure of the operation. Results: 1020 MIPs were performed with 23 (2.2%) failures. 1 patient was found to have benign familial hypercalcaemia, 5 were lost to follow up. Of the remaining 17 patients, average age was 62, and 76% were female. Reasons for failure in these patients were: 10 patients (59%) found to have double adenomas, 3 (17%) patients with hyperplasia and 4 (24%) patients with single gland disease missed at initial operation. All 17 were cured on repeat exploration. Of these 11 (65%) had repeat Sestamibi scans that correctly localized remaining hyperfunctioning gland(s). Conclusion: MIP can be performed safely without the need for IOPTH. The most common cause of failure after MIP is an occult double adenoma. Given that repeat Sestamibi scan correctly identifies persistent disease consideration can be given to MIP as a choice of procedure for repeat operation.