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18-05-2006 | Thyroid | Article

Factors influencing performance of minimally invasive parathyroidectomy outlined


Meeting website

Modern diagnostic imaging techniques and intra-operative monitoring of hormone levels may increase the frequency and reliability with which surgeons can perform parathyroid gland removals by minimally invasive parathyroidectomies (MIP), researchers believe.

This statement emerges from findings presented in a poster at the annual meeting of the American Association of Clinical Endocrinologists (AACE) in Chicago, Illinois, USA.

“The main goal of MIP is to reduce the size of the incision and related morbidities, including pain and potential nerve damage to the patient's vocal cords,” explained Vijay Jayaraman from the Medical College of Wisconsin, Milwaukee, USA.

However, “if 200 patients were to show up in your office, right off the bat, you’d have to cut 48%, or 96, from the list of potential candidates for the MIP, because you didn't have positive imaging, or couldn't localize the problem to one spot,” he added.

Jayaraman and co-workers therefore assessed how often it was possible to perform MIP among 200 individuals who attended his institution between September of 2003 and November of 2005, and what factors contributed to the decision to perform MIP.

During the study period, the MIP technique was planned for 104 patients. All the patients were screened with both radionuclide scanners and ultrasounds that allowed the investigators to determine which of 4 glands contained adenomas.

Some patients had thyroid gland involvement, as well as parathyroid troubles, he said, but other patients were more difficult to assess because they had short necks.

In 10 of the 104 patients, the operation required conversion from a minimally invasive approach to a unilateral one, and to a bilateral neck exploration in 11 cases, Jayaraman said.

Also contributing to more certainty in the operations was the use of intraoperative parathyroid hormone monitoring. “During surgery, you can tell when you pluck the right gland out, because there should be a drop in hormone levels, which is detectable in about 12 minutes,” Jayaraman told delegates.

The fact that malignant parathyroid tumors are rare also contributes to the ease of the operation, he added.