Parathyroid surgery

1. How is parathyroid surgery performed?: Overview

Figure 6: Intra-operative photo

The traditional technique for parathyroid surgery was bilateral neck explorationBilateral neck exploration - An operation where the surgeon examines all four parathyroid glands., in which the surgeon identifies all four of the parathyroid glands and determines which glands are diseased based on the size and appearance of the glands. This technique has been proven over time to be very safe and effective when performed by an experienced surgeon. However, since 80-85% of patients with PHPPHP - primary hyperparathyroidism have only one gland that is abnormal, many surgeons have shifted to doing a more limited and less invasive operation in patients thought to have a high likelihood of having a single abnormal gland. This more limited approach is often referred to as a focused parathyroidectomyFocused Parathyroidectomy - An operation where the surgeon examines and removes just the hyperactive parathyroid gland and not all four parathyroids. . In a focused parathyroidectomy, the surgeon goes after and removes only the hyperactive gland that is identified on pre-operative localizing testsLocalizing tests - Any test that is used to find or "localize" abnormal parathyroid gland(s). The most common are sestamibi scan and ultrasound.. The term "minimally invasive parathyroid surgery" is often used to refer to focused parathyroidectomy, but really can be used for any parathyroid operation done through a very small incision. The length of the operation will vary depending on multiple factors including patient characteristics, whether a single gland is removed or if an exploration of both sides of the neck with removal of multiple glands is performed, and whether the operation is a first time surgery or a re-operation. Depending on the complexity of the surgery, the operation may last as little as 20 minutes or as long as several hours.

There are many variations in how parathyroid surgery is performed based on surgeon preference. When deciding on a surgeon, it is important to remember that the type of technique used is far less important than the surgeon's personal experience and success rate. For example, whether the surgeon uses a radioguided technique or pre-operative imaging-based technique makes little difference when compared to the experience of the surgeon. Research has proven that the chance of being cured and of not having a complication after parathyroid surgery depends on the experience of the surgeon. ⁶² In general, a surgeon should do more than 50 parathyroid operations a year to be considered an expert. Every surgeon has developed an approach based on their own experiences and resources that works well for them, so please discuss with your surgeon what approach they will use. Below is a description of some of the more commonly used techniques.