Bilateral Neck Exploration with Intraoperative iPTH Assay in the ERA of Minimaly Invasive Parathyroidectomy

• Authors: Marcin Barczyński , Aleksander Konturek , Małgorzata Stopa , Filip Gołkowski , Alicja Hubalewska-Dydejczyk , Stanisław Cichoń , Wojciech Nowak
• Languages of publication: EN

Abstracts

EN

At present, the majority of patients with sporadic primary hyperparathyroidism (pHPT) qualify to minimally invasive parathyroidectomy (MIP). Nevertheless, in some patients, especially those with multiglandular parathyroid disease, achieving normocalcemia necessitates bilateral neck exploration (BNE).The aim of the study was evaluation of current indications for BNE and results obtained employing this method in an endocrine surgery referral center.Material and methods. A prospective analysis included 385 patients with pHPT qualified to parathyroidectomy (300 to MIP and 85 to BNE procedures) in the period between 12/2002 and 05/2008. Prior to the procedure, all the patients underwent preoperative imaging diagnostic studies (scintiscans of the parathyroids and ultrasound of the neck). Intraoperative parathormone assay was carried out in the course of all the operations. Indications for BNE and therapeutic results were evaluated.Results. The most common indication for BNE was lack of preoperative location of a parathyroid adenoma in imaging studies aiming either at lateralization or regionalization (49.4%), followed by concomitant thyroid pathology that required surgical treatment (23.5%), MEN 1 syndrome (12.9%), long-term lithium therapy (5.9%), refusal of the patient to grant informed consent to a minimally invasive parathyroidectomy (5.9%) and MEN 2A syndrome (2.4%). In the discussed group, 31 subtotal parathyroidectomies were performed, along with ten resections of two parathyroid adenomas and 44 resections of single parathyroid adenomas. Intraoperative iPTH assay affected the extent of parathyroid tissues resection in eight (9.4%) cases. One case of persistent and one case of recurrent hyperparathyroidism were noted in the follow-up of mean 37.4 ± 19.4 months postoperatively.Conclusions. In an endocrine surgery referral center, BNE is a procedure of choice in patients suspected of multiglandular parathyroid disease (MEN 1 and 2A, familial pHPT, long-term lithium therapy), in cases when a pathological parathyroid has not been located preoperatively and in patients which refuse their consent to MIP. Supplementing BNE with intraoperative iPTH assay allows for maintaining the highest quality of surgical treatment.

Keywords

EN

primary hyperparathyroidism; multiglandular parathyroid disease; minimally invasive parathyroidectomy; bilateral neck exploration; intraoperative parathormone assay

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 1
• Pages: 29-37

Dates

published

1 - 1 - 2010

online

10 - 2 - 2010

Contributors

author

Marcin Barczyński

• 3 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Aleksander Konturek

• 3 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Małgorzata Stopa

• 3 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Filip Gołkowski

• Chair and Department of Endocrinology, Collegium Medicum Jagiellonian University, Cracow

author

Alicja Hubalewska-Dydejczyk

• Chair and Department of Endocrinology, Collegium Medicum Jagiellonian University, Cracow

author

Stanisław Cichoń

• 3 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Wojciech Nowak

• 3 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

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Identifiers

DOI

10.2478/v10035-010-0006-0