SUCCESSFUL MINIMALLY INVASIVE SURGERY IN PRIMARY HYPERPARATHYROIDISM AFTER COMBINED PREOPERATIVE ULTRASOUND AND COMPUTED-TOMOGRAPHY IMAGING

The hypothesis that due to the high prevalence of solitary adenoma and the accuracy of modern imaging techniques it should be possible to cu re a considerable number of patients by direct adenomectomy through a minimally invasive approach was tested in a consecutive series of 66 p atients with primary hyperparathyroidism, Preoperative parathyroid ima ging consisted. of a combination of (Doppler) ultrasound and spiral co mputed tomography with cine-loop reconstruction potentiality. If only one parathyroid adenoma was identified preoperatively, a minimally inv asive approach was advised. If more than one adenoma was located, or w hen the imaging results were equivocal, the patient was advised to und ergo a conventional bilateral neck exploration. Sixty-six patients (54 female, 12 male) with a median age of 60 years and a median serum cal cium of 2.90 mmol L-1 were studied. Fifty-one of these patients underw ent minimally invasive surgery, which was successful in 49 patients, w hile conversion to conventional neck exploration was necessary in two patients, Conventional neck exploration was chosen for the other 15 pa tients. Six of these proved to have multiglandular disease or a retro- sternal adenoma, while in nine patients only one parathyroid adenoma w as found. All patients became normocalcaemic postoperatively. Morbidit y consisted of a transient unilateral vocal cord paralysis in one pati ent, These results support the original hypothesis: successful minimal ly invasive surgery was possible in 74% (49 of 66) of patients, thus a voiding conventional neck exploration. This strategy further simplifie s the operative treatment of primary hyperparathyroidism without loss of efficiency.