Minimally Invasive Parathyroidectomy Performed Under Loco-Regional Anaesthesia Versus General Anaesthesia: A Systematic Review and Meta-Analysis.

BACKGROUND

Traditionally bilateral cervical exploration (BCE) under general anaesthesia has been performed for cases of primary hyperparathyroidism (PHP) caused by a parathyroid adenoma. Imaging-guided minimally invasive parathyroidectomy (MIP) has been shown to be equally efficacious with less morbidity. This systematic review and meta-analysis aim to assess the safety and efficacy of MIP under locoregional anaesthesia (LRMIP) compared to general anaesthesia (GAMIP).

METHODS

SCOPUS, Cochrane Library, PubMed and Google Scholar databases were searched from inception to August 2024 to identify eligible comparative studies investigating minimally invasive parathyroidectomy under locoregional anaesthesia (LRMIP) versus general anaesthesia (GAMIP). The primary outcomes were cure and side effects. Secondary outcomes were recurrent/persistent hyperparathyroidism, post-operative nausea and vomiting, pain, use of analgesia, operating time, length of hospital stay, and patient satisfaction.

RESULTS

Seven research articles were included, two RCTs and five cohort studies, including 1046 patients. Cure rates, side effect profile, and recurrent/persistent hyperparathyroidism were comparable between both groups. Trends towards reduced post-operative nausea and vomiting were seen in LRMIP. The LRMIP group experienced a mean reduction of -1.26 for VAS pain scores (p < 0.04) and required fewer analgesics. Patient satisfaction with LRMIP appears comparable to GAMIP.

CONCLUSION

LRMIP appears comparable to GAMIP in respect of cure and safety profile, with reduced pain and potential benefits in PONV and recovery. LRMIP may be considered for selected patients undergoing parathyroidectomy for primary hyperparathyroidism. Larger prospective studies are needed prior to broader adoption.