- Title
- Pursuing the second ipsilateral gland during minimally invasive video-assisted parathyroidectomy
- Creator
- Bendinelli, Cino; Gray, Andrew; Suradi, Hassan; Weber, Dieter G.; Acharya, Shamasunder; Price, Anna; Mcgrath, Shaun
- Relation
- ANZ Journal of Surgery Vol. 88, Issue 4, p. E308-E312
- Publisher Link
- http://dx.doi.org/10.1111/ans.13956
- Publisher
- Wiley-Blackwell Publishing
- Resource Type
- journal article
- Date
- 2018
- Description
- Background: In patients with primary hyperparathyroidism (PHPT) and preoperative imaging suggesting a solitary parathyroid adenoma (SPA), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT. Unilateral neck exploration (UNE) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. We hypothesized that: (i) minimally invasive video-assisted (MIVA) approach would facilitate UNE and (ii) this would be a clinically relevant strategy. Methods: Prospective case series of a consecutive cohort of PHPT patients (with preoperative diagnosis of SPA), who underwent MIVA-UNE. A 15mm collar incision and endoscopic magnification were utilized to both excise the SPA and seek the ipsilateral parathyroid gland. Results: From 2009 to 2014, 132 patients were offered MIVA-UNE (age: 63.0 (interquartile range: 11.2); females: 94 (71.2%); symptomatic: 89 (67.4%); mean serum corrected calcium: 2.7 (standard deviation: 0.9) mmol/L; mean serum parathyroid hormone: 16.8 (standard deviation: 11.8) pmol/L). Conversion from MIVA-UNE to open UNE was required in 14 (10.6%) patients (excluded from subsequent analysis). MIVA-UNE was concluded in 118 patients. The second ipsilateral parathyroid was identified in 62 (52.5%) patients and in 13 (11.0%) it appeared enlarged and was excised. Histopathology confirmed five (4.2%) of these glands to be hyperplastic. Conclusion: MIVA-UNE allows identification of the second ipsilateral parathyroid in about half the patients. This approach helped to diagnose and treat unexpected multigland disease in almost 5% of patients.
- Subject
- primary hyperparathyroidism; minimally invasive video-assisted parathyroidectomy; unilateral neck exploration
- Identifier
- http://hdl.handle.net/1959.13/1383591
- Identifier
- uon:31960
- Identifier
- ISSN:1445-1433
- Language
- eng
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