Top

Langenbeck's Archives of Surgery

Published in:

01-01-2013 | Original Article

Feasibility of video-assisted bilateral neck exploration for patients with primary hyperparathyroidism and failed or discordant localization studies

Authors: Pier Francesco Alesina, Jakob Hinrichs, Matthias Heuer, Sebastian Hofmeister, Beate Meier, Martin K. Walz

Published in: Langenbeck's Archives of Surgery | Issue 1/2013

Abstract

Purpose

Minimally invasive video-assisted parathyroidectomy (MIVAP) is generally adopted for patients affected by primary hyperparathyroidism (pHPT) with clear preoperative localization. Standard bilateral neck exploration (BNE) is considered the obligate surgery for patients with unlocalized glands. We reviewed our experience of minimally invasive video-assisted BNE in patients with pHPT and negative or discordant localization studies.

Methods

From a prospective series of 576 MIVAP for pHPT, 107 patients (19 males, 88 females; mean age 58 years) with failed localization studies underwent BNE using the video-assisted technique. Operative time, complications, conversions to standard cervical exploration, and cure rate were analyzed.

Results

MIVAP with BNE was successfully completed in 99 (93 %) patients with 8 conversions. Mean operative time was 57 ± 37 min (range 20–180 min). Permanent recurrent laryngeal nerve palsy occurred in one patient. Biochemical cure was achieved in 104 patients (97 %). Five patients required a reoperation in the immediate postoperative period, which achieved cure in four. Two patients remained with persistent disease; one developed recurrence disease 3 years after the first exploration.

Conclusion

In experienced hands, video-assisted BNE for pHPT is feasible and safe and provides results equivalent to the conventional open technique.

Lombardi CP, Raffaelli M, Traini E, De Crea C, Corsello SM, Bellantone R (2009) Video-assisted minimally invasive parathyroidectomy: benefits and long-term results. World J Surg 33(11):2266–2281. doi:10.1007/s00268-009-9931-7 PubMedCrossRef

Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. Am J Roentgenol 188(6):1706–1715. doi:10.2214/AJR.06.0938 CrossRef

Harari A, Zarnegar R, Lee J, Kazam E, Inabnet WB 3rd, Fahey TJ 3rd (2008) Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery 144(6):970–976. doi:10.1016/j.surg.2008.08.029, discussion 976–979PubMedCrossRef

Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, Picone A, Marcocci C (1997) Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Investig 20(7):429–430

Walz MK, Lederbogen S, Limmer JC, Peitgen K, Mann K (2001) [Video-assisted hemithyroidectomy: surgical technique and early results]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 72(9):1054–1057

Miccoli P, Berti P, Materazzi G, Massi M, Picone A, Minuto MN (2004) Results of video-assisted parathyroidectomy: single institution’s six-year experience. World J Surg 28(12):1216–1218. doi:10.1007/s00268-004-7638-3 PubMedCrossRef

Alesina PF, Singaporewalla RM, Walz MK (2010) Video-assisted bilateral neck exploration in patients with primary hyperparathyroidism and failed localization studies. World J Surg 34(10):2344–2349. doi:10.1007/s00268-010-0700-4 PubMedCrossRef

Alesina PF, Hinrichs J, Kribben A, Walz MK (2010) Minimally invasive video-assisted parathyroidectomy (MIVAP) for secondary hyperparathyroidism: report of initial experience. Am J Surg 199(6):851–855. doi:10.1016/j.amjsurg.2009.05.041 PubMedCrossRef

Moalem J, Guerrero M, Kebebew E (2009) Bilateral neck exploration in primary hyperparathyroidism—when is it selected and how is it performed? World J Surg 33(11):2282–2291. doi:10.1007/s00268-009-9941-5 PubMedCrossRef

10.

Chiu B, Sturgeon C, Angelos P (2006) What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy. Surgery 140(3):418–422. doi:10.1016/j.surg.2006.03.021 PubMedCrossRef

11.

Sebag F, Hubbard JG, Maweja S, Misso C, Tardivet L, Henry JF (2003) Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery 134(6):1038–1041. doi:10.1016/j.surg.2003.07.021, discussion 1041–1042PubMedCrossRef

12.

Thier M, Nordenstrom E, Bergenfelz A, Westerdahl J (2009) Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy–a feasibility study. Langenbeck’s Arch Surg / Deutsche Gesellschaft fur Chirurgie 394(5):881–884. doi:10.1007/s00423-009-0524-6 CrossRef

13.

Miccoli P, Berti P, Materazzi G, Ambrosini CE, Fregoli L, Donatini G (2008) Endoscopic bilateral neck exploration versus quick intraoperative parathormone assay (qPTHa) during endoscopic parathyroidectomy: a prospective randomized trial. Surg Endosc 22(2):398–400. doi:10.1007/s00464-007-9408-4 PubMedCrossRef

14.

Gauger PG, Agarwal G, England BG, Delbridge LW, Matz KA, Wilkinson M, Robinson BG, Thompson NW (2001) Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery 130(6):1005–1010. doi:10.1067/msy.2001.118385 PubMedCrossRef

15.

Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG (2004) Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg 28(2):187–192. doi:10.1007/s00268-003-7255-6 PubMedCrossRef

16.

Lombardi CP, Raffaelli M, Traini E, Stasio E, Carrozza C, Crea C, Zuppi C, Bellantone R (2008) Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease. Langenbeck’s Arch Surg 393(5):639–645. doi:10.1007/s00423-008-0384-5 CrossRef

17.

Mozzon M, Mortier PE, Jacob PM, Soudan B, Boersma AA, Proye CA (2004) Surgical management of primary hyperparathyroidism: the case for giving up quick intraoperative PTH assay in favor of routine PTH measurement the morning after. Ann Surg 240(6):949–953, discussion 953–944PubMedCrossRef

18.

Stalberg P, Sidhu S, Sywak M, Robinson B, Wilkinson M, Delbridge L (2006) Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: does it “value-add” to decision-making? J Am Coll Surg 203(1):1–6. doi:10.1016/j.jamcollsurg.2006.03.022 PubMedCrossRef

19.

Hughes DT, Miller BS, Doherty GM, Gauger PG (2011) Intraoperative parathyroid hormone monitoring in patients with recognized multiglandular primary hyperparathyroidism. World J Surg 35(2):336–341. doi:10.1007/s00268-010-0887-4 PubMedCrossRef

20.

Bergenfelz AO, Wallin G, Jansson S, Eriksson H, Martensson H, Christiansen P, Reihner E (2011) Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. Langenbeck’s Arch Surg / Deutsche Gesellschaft fur Chirurgie 396(1):83–90. doi:10.1007/s00423-010-0724-0 CrossRef

21.

Dy BM, Richards ML, Vazquez BJ, Thompson GB, Farley DR, Grant CS (2012) Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol. doi:10.1245/s10434-012-2325-3

22.

Tang T, Dolan S, Robinson B, Delbridge L (2007) Does the surgical approach affect quality of life outcomes?—a comparison of minimally invasive parathyroidectomy with open parathyroidectomy. Int J Surg 5(1):17–22. doi:10.1016/j.ijsu.2006.01.008 PubMedCrossRef

Title: Feasibility of video-assisted bilateral neck exploration for patients with primary hyperparathyroidism and failed or discordant localization studies
Authors: Pier Francesco Alesina
Jakob Hinrichs
Matthias Heuer
Sebastian Hofmeister
Beate Meier
Martin K. Walz
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1033-6

At a glance: The STEP trials

Springer Medicine

Feasibility of video-assisted bilateral neck exploration for patients with primary hyperparathyroidism and failed or discordant localization studies

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis

The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma—indication, technique and results

Necrotizing fasciitis: is the bacterial spectrum changing?

Cinacalcet effects on the perioperative course of patients with secondary hyperparathyroidism

Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients

Surgical management of Crohn’s disease