ENDOCRINE SURGERY UNDER HYPNOSIS - A NEW SURGICAL STRATEGY IN HYPERPARATHYROIDISM

The elective unilateral approach, sometimes under local anaesthesia, o ffers many advantages in terms of less invasive and faster surgical ap proach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of m ultiglandular disease, free from thyroid disease and for whom localiza tion studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only explorating t he four glands but also of performing a partial thyroidectomy if neede d. In our experience 21 patients underwent a cervicotomy under hypnose dation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative lime was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (amo ng them a MEN-I case), and in one last case to a double adenoma. The f our glands were identified in 85 %. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medi cal and economic advantages than the unilateral access under local ana esthesia. Moreover indications are not restricted to selected patients .