外科ジャーナル

Conventional Minimally Invasive Parathyroidectomy for Single Parathyroid Adenoma

Abstract

Cristian Velicescu, Radu Danila, Alexandru Grigorovici, Christina Ungureanu, Cristina Cristea, Alina Gatu, Adi-Ionut Ciumanghel and Dumitru D Branisteanu

Background: Minimally invasive parathyroidectomy is actually the gold standard in the treatment of primary hyperparathyroidism (PHPT) due to parathyroid adenoma (PA).

Material and Methods: A clinical retrospective study was performed on a series of 40 cases operated for pHPT by single PA from January 2013 to March 2015, in the surgical department of the “St. Spiridon” Hospital of Iasi, a refferal center for endocrine surgery. Biochemical markers achieved the diagnosis of PHPT and PA was localized using cervical US and MIBI scintigraphy. Conventional minimally invasive parathyroidectomy (C-MIP) was performed in all cases where PA was accurately localised by preoperative imaging, whereas conventional cervical exploration was necessary in cases with concomitant thyroid pathology.

Results: Preoperative localisation findings were concordant with the intraoperative findings, except for one case when conversion to bilateral exploration was deemed and the PA was identified on the other side. In 8 cases, additional thyroid pathology – uni/multinodular goiter and a papillary microcarcinoma imposed a conventional PT adenomectomy and concomitant lobectomy/total thyroidectomy. The values of calcemia and PTH decreased significantly postoperatively and reached normal range in all cases. With the exception of a transient reccurrent nerve paresis (in a patient with total thyroidectomy), no postoperative morbidity and mortality was encountered.

Conclusion: Conventional mini-incision parathyroidectomy (C-MIP) has an excellent cure rate and minimal morbidity, with a reduced hospital stay and cost compared with the conventional extensive approach.