Minimal incision parathyroidectomy: Cure, cosmesis, and cost

The goals of operative treatment of primary hyperparathyroidism are (1) cur e; (2) minimal invasion; and (3) cost-effectiveness. The optimal strategy i s controversial. Retrospective review, of was undertaken 66 previously unop erated patients having minimal-incision, full-neck exploration by one surge on over 29 months. A group of 51 women and 15 men had open full neck explor ation under general anesthesia through a small (25-40 mm) incision using sp ecifically selected instruments; patients remained hospitalized overnight, Preoperative sestamibi scans were obtained before referral for 17 patients: 11 had localized disease, and 6 did not (65% sensitivity). Four parathyroi d glands were identified in 98% of patients; intraoperative frozen section was used selectively on a median of one gland per patient. About 76% of pat ients had single-gland disease, 6% had two-gland disease, and 18% had four- gland hyperplasia, One patient had four normal cervical parathyroid glands and an aorto-pulmonary window parathyroid adenoma resected at thoracotomy 1 week later; preoperative sestamibi scans failed to localize his disease, T here mere no nerve injuries and a 98% cure rate after initial cervical expl oration, Excluding the cost of the sestamibi scans, there was no difference between those who had preoperative localization and these who did not; 60% of hospital costs were operating room time-related, Minimal-incision parat hyroidectomy is effective for curing hyperparathyroidism and has excellent cosmetic results with negligible scar. Preoperative sestamibi scanning had no impact on cure or treatment costs. Strategies to improve cost-effectiven ess must address the substantial costs of anesthesia and operating room ser vices.