Minimally invasive surgery for primary hyperparathyroidism: A systematic review

Background: The aim of the present paper was to systematically review the l iterature regarding the safety and efficacy of minimally invasive parathyro idectomy techniques in patients with primary hyperparathyroidism. Studies u sing unilateral or endoscopic exploration following imaging were compared w ith bilateral open neck exploration. Methods: Studies on minimally invasive parathyroid surgery were identified using MEDLINE (1984 to August 1998), EMBASE (1974 to August 1998) and Curre nt Contents (1993 to week 34, 1998). The search terms were ((endoscop* or ( minimal* and invasive) or unilateral) and parathyroid). The Cochrane Librar y was searched from 1966 to issue 3 1998, using the search terms 'parathyro idectomy or parathyroid resection'. Human studies of patients with primary hyperparathyroidism using unilateral or endoscopic exploration were include d. Animal studies describing minimally invasive technique development were also included. A surgeon and researcher independently assessed the retrieve d articles for their inclusion in the review. Studies directly comparing th e unilateral method with bilateral open neck exploration were used to analy se outcomes. Results: Analysis of data using odds ratios and 95% confidence intervals (C I) indicated a tendency to favour the unilateral technique. These individua l studies generally had large CI, however; therefore preference to the unil ateral procedure cannot be espoused with certainty. There is also a selecti on bias due to the strict enrolment criteria for unilateral surgery. Conclusions: The proposed role of minimally invasive parathyroid surgery is for patients with primary hyperparathyroidism who have unilateral parathyr oid pathology. To assess the safety and efficacy of minimally invasive tech niques it is suggested that their introduction be monitored as part of a tr ial in Australia, from which data should be accrued to a register.