Minimally Invasive Parathyroid Surgery

What is the traditional approach to parathyroid surgery?
Using a traditional approach, the entire neck is explored through a 2-4 inch incision with examination of all four parathyroid glands.  Parathyroid glands are compared by size.  Larger glands are assumed to be abnormal(overactive) and removed.  Intra-operative pathologic examination of the glands can be obtained in an attempt to help confirm abnormal parathyroid gland tissue.

What are the disadvantages of the traditional approach to parathyroid surgery?
Larger incisions are more painful and less cosmetically appealing.
Examination of the entire neck puts all four parathyroid glands and both recurrent laryngeal nerves at risk for injury. 
Extensive dissection is associated with a higher risk of post-operative bleeding and most patients are observed overnight in the hospital.
Parathyroid gland size and intra-operative pathologic examination of gland tissue are poor criteria for determining complete removal of overactive parathyroid glands.  Additional overactive parathyroid glands can be present in unforeseen locations in the neck and chest.  The traditional surgical approach can miss these “hidden sources” of excessive parathyroid hormone production.  In such cases, a traditional neck exploration may fail to cure hyperparathyroidism.

What is Minimally Invasive Radioguided Parathyroidectomy (MIRP)?
MIRP is a minimally invasive method of removing abnormal parathyroid glands.  The procedure requires that overactive parathyroid gland(s) be identified pre-operatively by careful ultrasound examination of the neck and/or by uptake of a radioactive tracer called Sestamibi.  Sestamibi (given by intravenous injection) is taken up by the thyroid and parathyroid glands.  Over 2 hrs, Sestamibi “washes out” of normal thyroid and parathyroid tissue, leaving overactive parathyroid glands with higher levels radioactivity.  A thin intra-operative probe can then be used to identify and help remove radioactive (abnormal) parathyroid glands.  Usually, this procedure can be performed through a small, 1” inch incision.

What are the benefits of Minimally Invasive Radioguided Surgery?
Small incisions are less painful and are cosmetically superior.
Pre-operative ultrasound and Sestamibi directed surgery allows for limited examination of the neck and therefore a lower risk of injury to the recurrent laryngeal nerves and normal parathyroid glands.
Less surgical dissection reduces the risk of post-surgical bleeding.  Most patients can safely go home the same day of surgery.

Is Minimally Invasive Radioguided Parathyroidectomy the perfect surgery?
Unfortunately, removal of all radioactive parathyroid tissue does not guarantee removal of all overactive parathyroid tissue.  Additional surgeries may be necessary to identify missed sources of abnormal parathyroid hormone production.

What can be done to maximize the likelihood that my hyperparathyroidism will be cured with a single procedure?
Careful, pre-operative high resolution ultrasound evaluation of the neck can help to confirm the findings of a Sestamibi scan.  In some cases additional abnormal parathyroid glands may be identified.  By combining pre-operative neck ultrasound with Sestamibi scanning an optimal outcome can be achieved.

Development a rapid parathyroid hormone assay in the 1990s allowed for real time evaluation of a patients’ parathyroid hormone level during surgery.  Parathyroid hormone levels can be examined before and after removal of an abnormal appearing parathyroid gland.  A decrease of greater than 50% in blood parathyroid hormone levels confirms removal of all abnormal (overactive) parathyroid tissue.  Less than a 50% drop prompts a search for additional abnormal parathyroid glands and thus reduces the likelihood of a failed surgery.

How do Ft. Lauderdale Endocrine Surgery physicians optimize my surgical experience?

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