COMPLICATIONS
Among the possible harms of the unilateral minimally
invasive technique compared with the bilateral open neck exploration
is the rupture of the adenoma during its removal through a small incision.
Cell spillage, leading to parathyromatosis could result. Therefore
great care must be observed in removing parathyroid lesions through
limited exits (11).
Mild transient postoperative hypocalcemia, as a
result of significant hungry bone syndrome, recurrent laryngeal nerve
injury, injury to the normal parathyroid glands, or permanent alteration
of the normal tissue planes in the central neck were also reported
as other possible complications.
CONCLUSION
Despite
the high cure rate and low morbidity of the traditional bilateral
neck exploration observed over the past few decades in hyperparathyroid
patients, it is being currently replaced by a direct adenomectomy
through a unilateral small incision. This minimally invasive technique
is theoretically sufficient whenever an adenoma is localized preoperatively
with the complimentary use of sestamibi scan and ultrasnography,
since sporadic primary hyperparathyroidism is caused by a solitary
adenoma in 85 to 90% of patients. Different variations of this technique
have been proposed all aimed at minimizing the surgical trauma and
incision, lowering the cost, limiting exploration and decreasing
hospital stay, while maintaining excellent outcomes without compromising
patient safety.
The
experience of the surgeon is of paramount importance for the success
of the minimally invasive parathyroidectomy, just like in any other
surgical procedure.
REFERENCES
1.
Boggs JE, Irvin GL, Carneiro DM, Molinari AJ. The evolution of parathyroidectomy
failures. Surgery 1999; 126: 998-1002.
2.
Falke T, Schipper J, Patton J, Sandler P. Parathyroid glands. In
: Sandler M, Patton J, Gross M, Shapiro B, Falke T, editors. Endocrine
Imaging, Connecticut: Appleton and Lange, 1992; 149-173.
3.
Inabnet W, Fulla Y, Richard B, Bonnichon P, Icard P, Chapuis Y.
Unilateral neck exploration under local anesthesia : the approach
of choice for asymptomatic primary hyperparathyroidism. Surgery
1999; 126 : 1004-1009.
|
4.
Mallette L. Hyperparathyroidism. In : Mazzaferri EL, Samaan NA,
editors. Endocrine Tumors. Boston : Blackwell Scientific Publications,
1993; 625-670.
5.
Bringhurst FR, Demay M, Kronenberg H. Hormones and disorders of
mineral metabolism. In : Wilson J, Foster D, Kronenberg H, Larsen
PR, editors. Williams Textbook of Endocrinology. Pennsylvania :
W.B Saunders Company, 1998; 1155-1209.
6.
Kumar A, Cozens NJA, Nash JR. Sestamibi scan directed unilateral
neck exploration for primary hypeerparathyroidism due to a solitary
adenoma. European Journal of Surgical Oncology 2000; 26: 785-788.
7.
Chen M , Sokoll L , Udelsman R. Outpatient minimally invasive parathyroidectomy:
a combination of ssestamibi-SPECT localization, cervical block anesthesia,
and intraoperative parathyroid hormone assay. Surgery 1999; 126:
1016-1021.
8.
Sokoll L, Drew H, Udelsman R. Intraoperative parathyroid hormone
analysis. Clinical Chemistry 2000; 46: 1662-1668.
9.
Dackiw A, Sussman J, Fritsche H, Delpassand E, Stanford P, Hoff
A, Gagel R, Evans D, Lee J. Relative contributions of technetium
Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection,
and the rapid parathyroid hormone assay to the surgical management
of hyperparathyroidism. Archives of Surgery 2000; 135: 550-555.
10.
Delbridge L, Dolan S, Hop T, Robinson B, Wilkinson M, Reeve T. Minimally
invasive parathyroidectomy : 50 consecutive cases. Medical Journal
of Austria 2000; 172: 418-422.
11.
Reeve T, Babidge W, Parkyn R, Edis A, Delbridge L, Devitt P, Maddern
G. Minimally invasive surgery for primary hyperparathyroidism. Archives
of Surgery 2000; 135: 481-486.
12.
Smit C, Borel Rinkes I, Van Dalen A, Van Vroonhoven T. Direct minimally
invasive adenomectomy for primary hyperparathyroidism. Annals of
Surgery 2000; 231: 559-565.
13.
Goldstein R, Belvinss L, Delbeke D, Martin W. Effect of minimally
invasive radioguided parathyroidectomy on efficacy, length of stay,
and costs in the management of primary hyperparathyroidism. Annals
of Surgery 2000; 231: 732-742.
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