Robert Udelsman1. 1. Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. robert.udelsman@yale.edu
Abstract
OBJECTIVE: To review the outcomes of 656 consecutive parathyroid explorations performed by a single surgeon and to compare the results of conventional and minimally invasive parathyroidectomy (MIP) techniques. SUMMARY BACKGROUND DATA: Traditional surgery for primary hyperparathyroidism (HPTH) involves bilateral cervical exploration, which is usually accomplished under general endotracheal anesthesia. The MIP technique involves preoperative localization with sestamibi scans, surgeon-administered cervical block anesthesia, directed exploration through a small incision, intraoperative rapid parathyroid hormone assay, and discharge within 2 to 3 hours of surgery. METHODS: Six hundred fifty-six consecutive patients with primary HPTH underwent exploration between January 1990 and March 2001. RESULTS: MIP was used with ever-increasing frequency beginning in March 1998. Four hundred one procedures (61%) were performed using the standard technique and 255 patients (39%) were selected for MIP. The success rate for the entire series was 98%, with no significant differences comparing traditional and MIP techniques. The overall complication rate of 2.3% reflects 3.0% and 1.2% rates in the standard and MIP groups, respectively. MIP was associated with approximately a 50% reduction in operating time, a sevenfold reduction in length of hospital stay, and a mean cost savings of $2,693 per procedure, which represents nearly a 50% reduction in total hospital charges. CONCLUSIONS: A dramatic and sustained shift has occurred in the surgical treatment of primary HPTH: MIP has replaced traditional exploration for most patients.
OBJECTIVE: To review the outcomes of 656 consecutive parathyroid explorations performed by a single surgeon and to compare the results of conventional and minimally invasive parathyroidectomy (MIP) techniques. SUMMARY BACKGROUND DATA: Traditional surgery for primary hyperparathyroidism (HPTH) involves bilateral cervical exploration, which is usually accomplished under general endotracheal anesthesia. The MIP technique involves preoperative localization with sestamibi scans, surgeon-administered cervical block anesthesia, directed exploration through a small incision, intraoperative rapid parathyroid hormone assay, and discharge within 2 to 3 hours of surgery. METHODS: Six hundred fifty-six consecutive patients with primary HPTH underwent exploration between January 1990 and March 2001. RESULTS: MIP was used with ever-increasing frequency beginning in March 1998. Four hundred one procedures (61%) were performed using the standard technique and 255 patients (39%) were selected for MIP. The success rate for the entire series was 98%, with no significant differences comparing traditional and MIP techniques. The overall complication rate of 2.3% reflects 3.0% and 1.2% rates in the standard and MIP groups, respectively. MIP was associated with approximately a 50% reduction in operating time, a sevenfold reduction in length of hospital stay, and a mean cost savings of $2,693 per procedure, which represents nearly a 50% reduction in total hospital charges. CONCLUSIONS: A dramatic and sustained shift has occurred in the surgical treatment of primary HPTH: MIP has replaced traditional exploration for most patients.
Authors: John Allendorf; Mary DiGorgi; Kathryn Spanknebel; William Inabnet; John Chabot; Paul Logerfo Journal: World J Surg Date: 2007-08-31 Impact factor: 3.352
Authors: Rachell R Ayers; Kirby Tobin; Rebecca S Sippel; Courtney Balentine; Dawn Elfenbein; Herbert Chen; David F Schneider Journal: J Surg Res Date: 2015-03-31 Impact factor: 2.192