Outpatient minimally invasive parathyroidectomy: A combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay

Background. Despite the high cure rate and low morbidity of bilateral neck exploration for primary hyperparathyroidism, there is a movement toward min imizing the process in terms of incision, cost, extent of exploration, and length of hospital stay, while maintaining excellent outcomes. Methods. Between March and November 1998, 33 Patients with primary hyperpar athyroidism underwent went minimally invasive parathyroidectomy. All had pr eoperative sestamibi-SPECT scans suggesting a single adenoma, underwent ant erior cervical bloch anesthesia by the surgeon, and were explored through a 1- to 4-cm incision. Intraoperative parathyroid hormone assays were perfor med before and 5 to 10 minutes after parathyroid resection. Outcomes were c ompared with those of 184 consecutive patients who underwent bilateral para thyroid exploration under general anesthesia by the same surgeon between Au gust 1990 and May 1996. Results, The mean age of the patients undergoing minimally invasive parathy roidectomy was 61 +/- 2 years, and 24 of the 33 patients were women. Thirty (91 %) had resection of a single adenoma under regional anesthesia; 26 of these were done as outpatient procedures. Three Patients underwent conver s ion to general anesthesia for bilateral exploration and were found to have multigland disease (two double adenomas, one hyerplasia). All 33 patients w ere normocalcemic postoperatively. There was no morbidity. When the minimal ly invasive parathyroidectomy and bilateral parathyroid exploration groups were compared they were found to be similar with respect to age, preoperati ve calcium and parathyroid hormone levels, cause of primary hyperparathyroi dism, weighs of resected glands, cure rates, and morbidity However the mini mally invasive parathyroidectomy group had a significantly shorter length o f hospital stay (0.3 +/- 0.2 vs 1.8 +/- 0.1 days, P < .001) and lower costs ($3174 +/- $386 vs $6328 +/- $292, P < .001). Conclusions. Minimally invasive parathyroidectomy is a safe cost-effective alternative to bilateral exploration and may be the procedure of choice for select patients with primary hyperparathyroidism.