Outpatient minimally invasive parathyroidectomy: A combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay

Herbert Chen, Lori J Sokoll, Robert Udelsman

Research output: Contribution to journalArticle

Abstract

Background. Despite the high cure rate and low morbidity of bilateral neck exploration for primary hyperparathyroidism, there is a movement toward minimizing the process in terms of incision, cost, extent of exploration, and length of hospital stay, while maintaining excellent outcomes. Methods: Between March and November 1998, 33 patients with primary hyperparathyroidism underwent minimally invasive parathyroidectomy. All had preoperative sestamibi-SPECT scans suggesting a single adenoma, underwent anterior cervical block anesthesia by the surgeon, and were explored through a 1- to 4-cm incision. Intraoperative parathyroid hormone assays were performed before and 5 to 10 minutes after parathyroid resection. Outcomes were compared with those of 184 consecutive patients who underwent bilateral parathyroid exploration under general anesthesia by the same surgeon between August 1990 and May 1996. Results. The mean age of the patients undergoing minimally invasive parathyroidectomy was 61 ± 2 years, and 24 of the 33 patients were women. Thirty (91%) had resection of a single adenoma under regional anesthesia; 26 of these were done as outpatient procedures. Three patients underwent conversion to general anesthesia for bilateral exploration and were found to have multigland disease (two double adenomas, one hyperplasia). All 33 patients were normocalcemic postoperatively. There was no morbidity. When the minimally invasive parathyroidectomy and bilateral parathyroid exploration groups were compared, they were found to be similar with respect of age, preoperative calcium and parathyroid hormone levels, cause of primary hyperparathyroidism, weight of resected glands, cure rates, and morbidity. However, the minimally invasive parathyroidectomy group had a significantly shorter length of hospital stay (0.3 ± 0.2 vs 1.8 ± 0.1 days, P <.001) and lower costs ($3174 ± $386 vs $6328 ± 292, P <.001). Conclusions. Minimally invasive parathyroidectomy is a safe, cost-effective alternative to bilateral exploration and may be the procedure of choice for select patients with primary hyperparathyroidism.

Original languageEnglish (US)
Pages (from-to)1016-1022
Number of pages7
JournalSurgery
Volume126
Issue number6
DOIs
StatePublished - 1999

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Parathyroidectomy
Single-Photon Emission-Computed Tomography
Parathyroid Hormone
Outpatients
Anesthesia
Primary Hyperparathyroidism
Length of Stay
Adenoma
Morbidity
Costs and Cost Analysis
General Anesthesia
Conduction Anesthesia
Hyperplasia
Neck
Calcium
Weights and Measures

ASJC Scopus subject areas

  • Surgery

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Outpatient minimally invasive parathyroidectomy : A combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. / Chen, Herbert; Sokoll, Lori J; Udelsman, Robert.

In: Surgery, Vol. 126, No. 6, 1999, p. 1016-1022.

Research output: Contribution to journalArticle

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abstract = "Background. Despite the high cure rate and low morbidity of bilateral neck exploration for primary hyperparathyroidism, there is a movement toward minimizing the process in terms of incision, cost, extent of exploration, and length of hospital stay, while maintaining excellent outcomes. Methods: Between March and November 1998, 33 patients with primary hyperparathyroidism underwent minimally invasive parathyroidectomy. All had preoperative sestamibi-SPECT scans suggesting a single adenoma, underwent anterior cervical block anesthesia by the surgeon, and were explored through a 1- to 4-cm incision. Intraoperative parathyroid hormone assays were performed before and 5 to 10 minutes after parathyroid resection. Outcomes were compared with those of 184 consecutive patients who underwent bilateral parathyroid exploration under general anesthesia by the same surgeon between August 1990 and May 1996. Results. The mean age of the patients undergoing minimally invasive parathyroidectomy was 61 ± 2 years, and 24 of the 33 patients were women. Thirty (91{\%}) had resection of a single adenoma under regional anesthesia; 26 of these were done as outpatient procedures. Three patients underwent conversion to general anesthesia for bilateral exploration and were found to have multigland disease (two double adenomas, one hyperplasia). All 33 patients were normocalcemic postoperatively. There was no morbidity. When the minimally invasive parathyroidectomy and bilateral parathyroid exploration groups were compared, they were found to be similar with respect of age, preoperative calcium and parathyroid hormone levels, cause of primary hyperparathyroidism, weight of resected glands, cure rates, and morbidity. However, the minimally invasive parathyroidectomy group had a significantly shorter length of hospital stay (0.3 ± 0.2 vs 1.8 ± 0.1 days, P <.001) and lower costs ($3174 ± $386 vs $6328 ± 292, P <.001). Conclusions. Minimally invasive parathyroidectomy is a safe, cost-effective alternative to bilateral exploration and may be the procedure of choice for select patients with primary hyperparathyroidism.",
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AB - Background. Despite the high cure rate and low morbidity of bilateral neck exploration for primary hyperparathyroidism, there is a movement toward minimizing the process in terms of incision, cost, extent of exploration, and length of hospital stay, while maintaining excellent outcomes. Methods: Between March and November 1998, 33 patients with primary hyperparathyroidism underwent minimally invasive parathyroidectomy. All had preoperative sestamibi-SPECT scans suggesting a single adenoma, underwent anterior cervical block anesthesia by the surgeon, and were explored through a 1- to 4-cm incision. Intraoperative parathyroid hormone assays were performed before and 5 to 10 minutes after parathyroid resection. Outcomes were compared with those of 184 consecutive patients who underwent bilateral parathyroid exploration under general anesthesia by the same surgeon between August 1990 and May 1996. Results. The mean age of the patients undergoing minimally invasive parathyroidectomy was 61 ± 2 years, and 24 of the 33 patients were women. Thirty (91%) had resection of a single adenoma under regional anesthesia; 26 of these were done as outpatient procedures. Three patients underwent conversion to general anesthesia for bilateral exploration and were found to have multigland disease (two double adenomas, one hyperplasia). All 33 patients were normocalcemic postoperatively. There was no morbidity. When the minimally invasive parathyroidectomy and bilateral parathyroid exploration groups were compared, they were found to be similar with respect of age, preoperative calcium and parathyroid hormone levels, cause of primary hyperparathyroidism, weight of resected glands, cure rates, and morbidity. However, the minimally invasive parathyroidectomy group had a significantly shorter length of hospital stay (0.3 ± 0.2 vs 1.8 ± 0.1 days, P <.001) and lower costs ($3174 ± $386 vs $6328 ± 292, P <.001). Conclusions. Minimally invasive parathyroidectomy is a safe, cost-effective alternative to bilateral exploration and may be the procedure of choice for select patients with primary hyperparathyroidism.

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