MINIMALLY INVASIVE PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM - DECREASING OPERATIVE TIME AND POTENTIAL COMPLICATIONS WHILE IMPROVING COSMETIC RESULTS

Primarily because of the lack of highly accurate preoperative localizi ng studies, the standard operation for primary hyperparathyroidism (HP TH) has consisted of bilateral neck exploration with examination of al l four parathyroid glands. Recent experience with the technetium-99m-S estamibi scan at our hospital has suggested that this single test was now accurate enough to allow unilateral neck exploration. This study w as designed to examine the efficacy and safety of minimally invasive p arathyroidectomy in select patients with a single adenoma demonstrated on a preoperative sestamibi. Eighteen consecutive patients with prima ry HPTH in whom a sestamibi scan suggested a single adenoma underwent unilateral neck exploration through a 2.5-cm incision, which was exten ded as necessary. Results were compared to the preceding 25 parathyroi d explorations for primary HPTH due to a single adenoma, which were no ndirected and included bilateral neck exploration. All patients underg oing minimal exploration were found to have a single adenoma and demon strated a normal serum calcium within 24 hours of surgery. Standard bi lateral exploration failed to locate the adenoma in one patient requir ing subsequent re-exploration. Operative time, incision length, and le ngth of hospital stay were all significantly less for those undergoing minimal exploration tall P < 0.01). There were no complications in ei ther group. Minimally invasive neck exploration is a safe and effectiv e treatment for primary HPTH, is easily accomplished under local anest hesia, and is associated with significant reductions in operative time and hospital stay. Limited exploration provides a better cosmetic res ult while decreasing the potential complications of bilateral explorat ion, but is dependent upon a high-quality sestamibi scan.