Pre-Operative Decision Making...
Who is a candidate for minimal parathyroid surgery?
Updated: January 2005.
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 It is clear that ALL patients with primary hyperparathyroidism are candidates for minimally invasive
parathyroid surgery using intraoperative nuclear mapping. ALL
parathyroid patients can take advantage of using a
radioactive-detection probe during the surgery, and many of the
other lessons that
we have learned while performing mini-parathyroid surgery--even if
they need all four parathyroid glands examined. Yes, Yes, Yes... ALL
patients can have a mini-operation, and ALL patients can go home within hours of
the operation.
Who can have the smallest of all
parathyroid operations... the MIRP? -- EVERYBODY.
However, we still distinguish between those found to have a single radioactive
parathyroid gland on high-quality sestamibi scan and those who's
scan does not show a single parathyroid tumor. Remember, about 4-5 percent of all patients with primary hyperparathyroidism will have four-gland hyperplasia (or the more rare multiple
parathyroid adenoma)...they require exploration of all four
parathyroid glands.
Of the 95-96 percent of patients that have a single bad parathyroid
gland, some will not have a sestamibi scan which shows which
parathyroid gland is the bad parathyroid.
 HOWEVER.
EVERYBODY CAN HAVE A MINI OPERATION WHEN PERFORMED BY A FEW EXPERTS
WHO DO THIS OPERATION DAILY. Somewhere between
87 and 90 percent of all patients with this disease will end up
having a the smallest and quickest of all operations. As centers have gained more experience over the past year or two, this rate has climbed gradually.
Editor's Note: The author's institution (Norman
Parathyroid Clinic) performs a mini-parathyroid operation on ALL
patients! Even those that need 4 gland parathyroid exploration
avoid general anesthesia and get a 1 to 1.25 inch incision.
parathyroid surgery, parathyroid operation
parathyroid disease, parathyroid surgery
Localizing studies are not always
required prior to the morning of the operation. Studies other than sestamibi are rarely helpful and unnecessary, and there is usually no reason to get the sestamibi prior to the day of
surgery (unless you are traveling a long way for the operation, it
is often helpful to get the scan ahead of time so the trip can be
planned better). When the diagnosis of primary hyperparathyroidism is made, the patients are
scheduled for the operating room and entered into the following protocol:
parathyroid surgery parathyroid operation, parathyroid disease
The minimally invasive approach
to parathyroid surgery is performed using local anesthesia or a very
"light general" anesthesia using sedation drugs given IV, and most patients are sent home
an hour or two following the
operation. The same-day surgery rate should average better than 98 percent of ALL parathyroid patients, with the others sent home the following morning.
Those undergoing a standard bilateral parathyroid exploration
should almost always be sent home the same day as well, although
some surgeons will elect to keep their patients overnight for a
"23-hour stay". It is becoming quite uncommon for patients to stay longer than 23 hours following routine standard
parathyroid surgery. But, underlying diseases and other conditions such as age greater than ~75 will increase the likelihood of staying longer. REMEMBER...the emphasis is on quality of care and
cure of the parathyroid disease, NOT on how fast the patient is sent home!
What if your hospital doesn't have a nuclear probe? These probes have only become widely available during
the late 1990's. The probes are EXPENSIVE, about $125,000. Because of
this, many hospitals won't buy the probe for parathyroid
exploration, because it is not worth it since their surgeons only do
a couple of parathyroid operations per year. Even without a miniature probe, a number of surgeons are performing unilateral neck explorations for patients who have been identified as having a single bad parathyroid gland (as opposed to 4 gland hyperplasia). These patients are usually identified as such by a preoperative sestamibi scan. Even without the probe, the operation can be limited greatly in scope by exploring only the side of the neck which harbors the single enlarged (overactive) parathyroid gland.
Not all surgeons have embraced the concept of not examining all 4 parathyroid glands.
Those days are gone! To read more about the different cure
rates for surgeons with different levels of experience, go
to this page of Parathyroid.com. Bottom
line: Surgeons who perform only a few parathyroid operations per
year have a cure rate of approximately 85 %. Those who do more than
200 parathyroid operations per year have a cure rate of over 98%. CHOOSE
YOUR SURGEON CAREFULLY. The
complication rate is also MUCH less for surgeons who perform this
operation every week.
For another perspective
on Parathyroid Disease, go to our sister Web Page: Parathyroid.com
Parathyroid.com is the world's largest parathyroid web
site.
More about Dr. Norman and the Norman
Parathyroid Clinic.
Standard Parathyroid Operation, back to Minimal Parathyroidectomy
More information on Sestamibi Scans or some of the other less useful tests to find a parathyroid.
Technical details on How to Perform Sestamibi.
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