>Year 2004, Issue 4
Lozano-Salazar RR, Pantoja JP, Herrera MF
Minimally invasive surgery of the parathyroid glands
Cir Gen 2004; 26 (4)
PDF: 4. Kb.
Objective: To analyze the principal minimally invasive techniques in parathyroid glands.
Setting: Third level health care hospital.
Design: Review article.
Selection of studies: The world literature on the subject from the last 5 years was reviewed (22 references).
Extraction of data: We searched for the epidemiological, diagnostic, and surgical aspects of the subject.
Results: Treatment of hyperparathyroidism (HPT) requires surgical procedures in most patients. The surgical techniques have undergone changes along time, going from the traditional bilateral exploration of the neck, identifying the 4 glands in the absence of localizing studies, to diverse minimally invasive techniques, which have as a common denominator the use of small incisions and unilateral exploration. Refinement of localization studies has allowed using these techniques in more than 85% of HPT patients. Another innovation consists in the use of fast measurements of the parathormone to confirm the cure of the disease. This article describes the most common minimally invasive techniques, such as: traditional, limited exploration, radio-guided, video-assisted, and endoscopy.
Conclusion: The variety of minimally invasive techniques and their similar results show that none is better than the others.
Palazzo FF, Sadler GP. Minimally invasive parathyroidectomy. BMJ 2004; 328: 849-50.
Potts JT Jr. Enfermedades de las glándulas paratiroides y otros procesos hipercalcémicos e hipocalcémicos. En: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martín JB, Kasper DL, et al, editors. Harrison. Principios de medicina interna 14ª ed. México: McGraw-Hill Interamericana; 1998. p 2534-57.
Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon´s choice of operative procedure. J Am Coll Surg 1998; 186: 293-305.
Inabnet WB. Radio-guided parathyroidectomy under local anesthesia. In: Gagner M, Inabnet WB (eds.). Minimally invasive endocrine surgery. Lippincott Williams & Wilkins, 2002: 103-110.
Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99 m) technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002; 57: 241-9.
Stratmann SL, Kuhn JA, Bell MS, Preskitt JT, O’Brien JC, Gable DR, et al. Comparison of quick parathyroid assay for uniglandular and multiglandular parathyroid disease. Am J Surg 2002; 184: 578–81; discussion 581.
Hindie E, Melliere D, Jeanguillaume C, Perlemuter L, Chehade F, Galle P. Parathyroid imaging using simultaneous double-window recording of technetium-99m-sestamibi and iodine-123. J Nucl Med 1998; 39: 1100-5.
Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg 1998; 64: 391-5.
Henry JF, Defechereux T, Gramatica L, De Boissezon C. Endoscopic parathyroidectomy via a lateral neck incision. Ann Chir 1999; 53: 302-6.
Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT. Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 1998; 12: 202–5; discussion 206.
Miccoli P, Monchik JM. Minimally invasive parathyroid surgery. Surg Endosc 2000; 14: 987-90.
Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996; 83: 875.
Duh QY. Presidential Address: Minimally invasive endocrine surgery-standard of treatment or hype? Surgery 2003; 134: 849-57.
Sebag F, Hubbard JG, Maweja S, Misso C, Tardivet L, Henry JF. Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery 2003; 134: 1038-41; discussion 1041-2.
Miccoli P, Bendinelli C, Conte M, Pinchera A, Marcocci C. Endoscopic parathyroidectomy by a gasless approach. J Laparoendosc Adv Surg Tech A 1998; 8: 189–94.
Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002; 235: 665-70; discussion 670-2.
Sackett WR, Barraclough B, Reeve TS, Delbridge LW. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002; 137: 1055-9.
Carneiro DM, Irvin GL 3rd. Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. Surgery 2000; 128: 925-9; discussion 935-6.
Ferzli G, Patel S, Graham A, Shapiro K, Li HK. Three new tools for parathyroid surgery: expensive and unnecessary? J Am Coll Surg 2004; 198: 349–51.
Biertho L, Chu C, Inabnet WB. Image-directed parathyroidectomy under local anaesthesia in the elderly. Br J Surg 2003; 90: 738–42.
Berti P, Materazzi G, Picone A, Miccoli P. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003; 90: 743–7.
Henry JF, Iacobone M, Mirallie E, Deveze A, Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 2001; 130: 999-1004.
>Year 2004, Issue 4