ANZ journal of surgery · 2007
Minimally invasive parathyroidectomy: an audit of a change in clinical practice.
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Yew Ming K, Thompson Ivan J
Аннотация
BACKGROUND: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is gaining acceptance as a useful tool in the armamentarium of the endocrine surgeon.
METHODS: We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach.
RESULTS: Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation.
CONCLUSION: Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.
METHODS: We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach.
RESULTS: Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation.
CONCLUSION: Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.