Minimal Parathyroid Surgery
What Endocrinologists are Saying About it!

Also called: Minimally Invasive Radioguided Parathyroid Surgery, or "MIRP"

Aim: To determine the impact that MIRP is having on the way endocrinologists treat hyperparathyroidism. parathyroid parathyroid parathyroid parathyroid

Methods: The membership of the American Association of Clinical Endocrinologists was surveyed by mail regarding physician practices and surgical referral patterns for hyperparathyroidism. The survey utilized a visual analog scale (VAS) and multiple-choice questions. The associations were tested for significance using Chi-square and logistic regression. Data are mean±SEM.  parathyroid parathyroid

Results: The 788 responding endocrinologists had been practicing for an average of 17 years. They referred an estimated 63% of all patients with parathyroid overactivity for operative treatment, and typically utilized localizing studies prior to surgical referral (Sestamibi scan most commonly).  80% indicated that the availability of MIRP would (or has already) increase the number of patients referred for surgery, to near 95% of all of their patients with parathyroid disease. Endocrinologists identified symptoms, calcium homeostasis, bone density, health status, risk of general anesthesia, and patient age as the most important factors in their decision for surgical referral.

Endocrinologists also indicated that the availability of MIRP would change the extent and duration of their preoperative workup (p<0.0001). In other words, they overwhelmingly stated that if their patients could have a MIRP rather than a standard operation, they would order fewer tests and send the patient for an operation much sooner.  Younger endocrinologists were more likely to refer patients for MIRP (p=0.001) sooner and thus alter the extent of their preoperative work-up (p=0.03). 

More than 50% of endocrinologists stated that they had one or more patients who underwent a standard parathyroid operation who had a significant complication, or who were not cured by the operation.  These endocrinologists were more anxious to send their patients for a minimal parathyroid operation (p=0.02). 

Finally, when asked if they had to have a parathyroid operation themselves, 96.5% of all endocrinologists stated they would have a MIRP rather than a standard operation (p<0.000001). parathyroid parathyroid parathyroid parathyroid parathyroid parathyroid

Conclusions: These data confirm the clinical impression seen by the authors (Dr. Norman, et, al.) that MIRP lowers the threshold to refer hyperparathyroid patients for surgery. Moreover, MIRP is very likely to decrease the extent and duration of preoperative workup while decreasing the time from diagnosis to referral. Because of the perceived shortcomings of traditional parathyroidectomy, endocrinologists are rapidly embracing minimally-invasive parathyroid techniques validated by disciplined outcomes research