Also called: Minimally Invasive Radioguided Parathyroid Surgery
The article below is an abstract being presented at a major medical conference in the Spring of 2003 regarding parathyroid surgery. This research was conducted by the Endocrine Surgery Department at USF under the direction of Dr. James Norman, MD.
Board Certified Endocrinologists belonging to the American Association of Clinical Endocrinologists were surveyed. A total of 788 endocrinologists responded to this study.
Bottom line: If the endocrinologists had to have a parathyroid operation performed on themselves, 96% would have a MIRP!
Background: Minimally-Invasive Radioguided Parathyroidectomy (MIRP) appears to be changing the the way endocrinologists are treating patients with hyperparathyridism. Moreover, the frequency with which endocrinologists refer patients with primary hyperparathyroidism to a surgeon appears to be increasing significantly.
Aim: To determine the impact that MIRP is having on the way endocrinologists treat hyperparathyroidism.
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.
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).
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