Source: Epilepsy Curr  |  Posted 5 years ago

By John Otrompke

CHICAGO, I.L. -- May 2, 2006 -- Modern diagnostic imaging techniques and intra-operative monitoring of hormone levels may increase the frequency and reliability with which surgeons can perform parathyroid gland removals via the more efficient minimally-invasive method, according to a poster presented here at the annual meeting of the American Association of Clinical Endocrinologists (AACE).

"The main goal of minimally-invasive parathyroidectomies (MIP) is to reduce the size of the incision and related morbidities, including pain and potential nerve damage to the patient's vocal cords," said Vijay Jayaraman, MD, resident in surgery, Medical College of Wisconsin, Milwaukee, United States, in a presentation on April 27[^]th[].

"If 200 patients were to show up in your office, right off the bat, you'd have to cut 48%, or 96, from the list of potential candidates for the MIP, because you didn't have positive imaging, or couldn't localize the problem to one spot," said Jayaraman.

He noted that all the patients in the review were screened with both radionuclide scanners and ultrasounds to determine which of 4 glands contained adenomas.

Some patients had thyroid gland involvement, as well as parathyroid troubles, Dr. Jayaraman said, while other patients had short necks, which makes exploration more difficult. "And in some cases, you're dealing with re-operating, where a patient had already failed prior bilateral operation," he added.

From the analysis of 200 operations between September of 2003 -- when his institution began noting its preoperative decision as to which of 3 techniques are utilized for the procedure -- and November of 2005, the MIP technique was planned for 104 patients, Dr. Jayaraman said.

In 10 cases, the operation was converted from a minimally invasive approach to a unilateral one, and to a bilateral neck exploration in 11 cases, to see which gland is the biggest, Dr. Jayaraman said.

The minimally-invasive approach takes about 20 minutes to complete, the unilateral exploratory method takes 30 to 40 minutes, and the bilateral exploration -- the oldest modern surgical method of performing parathyroidectomies -- takes about 40 minutes, he said.

Also contributing to more certainty in the operations was the use of intraoperative parathyroid hormone (IOPTH) monitoring. "During surgery, you can tell when you pluck the right gland out, because there should be a drop in hormone levels, which is detectable in about 12 minutes," said Dr. Jayaraman.

The fact that malignant parathyroid tumors are rare also contributes to the ease of the operation, he said.

[Presentation title: Minimally Invasive Parathyroidectomy: How Often is it Possible? Poster 344]