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 ORIGINAL ARTICLE
Year : 2009  |  Volume : 55  |  Issue : 4  |  Page : 242-246

Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe


1 Ataturk Training and Research Hospital, Second Surgery, Izmir, Turkey
2 Endocrine,Izmir, Turkey
3 Radiology Clinics, Izmir, Turkey

Correspondence Address:
M Haciyanli
Ataturk Training and Research Hospital, Second Surgery, Izmir
Turkey
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Source of Support: None, Conflict of Interest: None


PMID: 20083868

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Background : Minimally invasive parathyroidectomy (MIP) is widely used worldwide for the treatment of primary hyperparathyroidism (pHPT). It is usually combined with a perioperative adjunct for high success rate. Aim : To demonstrate that MIP can be successfully performed in a selected group of patients with presumabally solitary adenoma as the cause of pHPT without using any perioperative adjuncts. Settings and Design : A prospective data analysis of two surgeons' series from a teaching hospital in Turkey. Materials and Methods : Of the 47 patients referred with a diagnosis of pHPT during January 2004-May 2008, 30(63%) patients with sporadic pHPT with presumed solitary adenoma were included for analysis. These patients underwent MIP via focused lateral ( n=24) or anterior ( n=6) approach. Preoperative localization was done using 99 mTc-labelled sestamibi scan and ultrasonography. Only patients with concordant tests for single adenoma were selected for MIP. Serum parathyroid hormone and calcium levels were measured postoperatively and at follow-up visits. Statistical Analysis : Parametric data presented were analyzed with Excel XP (Microsoft, Redmond, WA, USA). Results : Barring one patient, all other patients were initially biochemically cured by MIP. One patient remained hypercalcemic, who was found to have a second adenoma at the second operation. During a mean follow-up of 16 (3-55) months, all patients were normocalcemic with a mean serum calcium level of 9.4 (8.9-10.2) mg/dl. Parathormone levels were persistantly elevated only in one patient (3.4%). No postoperative permanent complication was encountered. Conclusion : The results of MIP achieved in high-volume endocrine surgery centers can be replicated in low-volume center without any intraoperative adjuncts, in patients with overt clinical pHPT and concordant results of sestamibi and ultrasound.






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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow