Primary hyperparathyroidism is a common endocrine disorder characterised by excessive secretion of parathyroid hormone from one or more parathyroid glands. As the parathyroid hormone regulates primarily the metabolism of calcium, it affects its absorption, excretion and deposits; namely in the digestive tract, the renal and the skeletal systems.
The causes of primary hyperparathyroidism have been traditionally documented as follows:
- Single Parathyroid Adenoma 84%
- Multiple Parathyroid Adenoma 1%
- Parathyroid Hyperplasia 14%
- Parathyroid carcinoma <1%
This is a benign disease, the prevalence of Parathyroid carcinoma is so low that is constitutes a rarity. Although there are medical therapies for management of hypercalcemia, primary hyperparathyroidism is best served by surgery. Minimally Invasive Parathyroidectomy (MIP) has gained adepts all over the world due to its safety, efficacy and outstanding cosmetic outcome.
The procedure relies heavily on preoperative localisation of the gland, fundamentally to rule out hyperplasia or multiple parathyroid adenomas that would force the surgeon into a bilateral exploration. We largely use a combination of Sestamibi scan and ultrasound. Lately we introduced the use of ultrasound in the operating theatres to more effectively localise the gland and minimise the rate of failures. In fact most failures of the procedure that would require a conversion into a conventional bilateral neck exploration are related mainly to inadequate preoperative localisation. These failures fortunately are becoming uncommon as preoperative localisation is becoming more precise.
Once the glands are localised the surgeon places a 2 cm incision and removes the affected gland using a lateral approach. This approach retracts the infrahyoid muscles medially allowing the excision of the gland through a minimal incision. The procedure is safe, effective and achieves a high degree of patient satisfaction.
The key to endocrine surgery is a surgeon who subspecialises in this particular field and has acquired the training and experience to safely perform these procedures with good results.
Dr Nicolás Oddone is a Surgical Oncologist and Head & Neck Surgeon who has a special interest in thyroid, parathyroid and salivary gland disorders as well as minimally invasive approaches. For more information on these procedures please contact us at Suite 302, 2 Technology Place, Macquarie University Hospital NSW 2109 or ring 02 9887 8899.
References:
1. D Fraker, H Harsono, R Lewis. Minimally Invasive Parathyroidectomy: Benefits and requirements of intraoperative localisation, diagnosis and intraoperative PTH Monitoring. Long Term Results. World J Surg (2009) 33:2256–2265.
2. O Hessman, J Westerdahl, N Al-Suliman et al. Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism. British Journal of Surgery 2010; 97: 177–184.
3. R Udelsman, P Donovan. Open minimally invasive parathyroid surgery. World J. Surg. 28, 1224–1226, 2004.
Dr Nicolás Oddone, Surgical Oncologist and Head & Neck Surgeon
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