Surgical Strategy in the Management of Primary Hyperparathyroidism

Yoon, Jong Ho; Chang, Hang Seok; Park, Cheong Soo

Abstract

PURPOSE
The objective of this study was to evaluate the outcomes of parathyroid surgery, by comparing conventional and minimally invasive parathyroidectomy (MIP), and to present our strategy for the surgical treatment of primary hyperparathyroidism. METHODS: A retrospective study was performed for a 24-year period (1980~2003), on 119 surgically explored patients with primary hyperparathyroidism. RESULTS: Sixty one procedures were performed using a conventional cervical exploration and 58 patients had been selected for MIP, such as radio-guided parathyroidectomy (MIRP) or focused parathyroidectomy (MIFP). There were no significant differences in the age distribution, serum calcium, phosphate and intact PTH levels between the conventional and MIP groups. However, the operative times and lengths of hospital stay were significantly decreased in the MIP group (P<0.01). The success rate of a 99mTc sestamibi scan was 98.3 % (57/58) in the MIP group. The surgical success rate for the entire series was 96.6%, with no significant differences between the conventional and MIP groups. CONCLUSION: The following surgical strategy is suggested for the management of primary hyperparathyroidism. If the 99mTc sestamibi scan shows a single, intense focus of uptake, consistent with the ultrasonographic findings, then an MIFP is likely to be successful. If no area, or multiple areas, of increased uptake is seen on the 99mTc sestamibi scan, consistent with ultrasonographic findings, or if the abnormal lesions are seen only on ultrasonography, then a bilateral cervical exploration should be performed. If a single focus of uptake is seen only on the 99mTc sestamibi scan, or if the location of a single lesion on the 99mTc sestamibi scan and ultrasonography do not match, then a MIRP is likely to be successful.