Minimally invasive parathyroidectomy under local anesthesia in connection with ultrasonography, sestamibi scintigraphy and intra-operative parathormone measurement

Introduction: The standard procedure in patients with primary hyperparathyr oidism (pHPT) includes cervical exploration and identification of all four enlarged parathyroid glands. New localization techniques, i.e., ultrasonogr aphy associated with color duplex sonography, Tc-99m-sestamibi scintigraphy and the possibility of intraoperative parathormone (iPTH) measurement perm it minimally invasive parathyroidectomy (MIP). Three different methods have been established: minimally invasive open parathyroidectomy, endoscopic pa rathyroidectomy and video-assisted parathyroidectomy. We present our experi ence with open MIP with the patient under local anesthesia (LA). Methods: I n 25 patients with pHPT the operation was started under local anesthesia. P reoperatively, ultrasonography and sestamibi scintigraphy were performed in each patient. iPTH measurement was carried out intraoperatively. Results: In 23 patients (92%) the operation was done successfully in LA. There were no postoperative complications. During follow-up none of the patients devel oped hypercalcemia again. Conclusion: MIP in connection with ultrasonograph y, sestamibi scintigraphy and intraoperative PTH measurement offers a promi sing treatment for patients with pHPT.