Top

Published in:

01-02-2017 | Original Scientific Report

Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution

Authors: Fausto Famà, Marco Cicciù, Francesca Polito, Antonio Cascio, Maria Gioffré-Florio, Arnaud Piquard, Olivier Saint-Marc, Alessandro Sindoni

Published in: World Journal of Surgery | Issue 2/2017

Abstract

Introduction

Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision.

Methods

In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5 min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n = 190) undergoing a standard immediate autotransplantation.

Results

We divided patients in two main groups: group A (n = 160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n = 236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P < 0.001): 91.9 % were transient and 8.1 % (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P = 0.616 vs. group A and P = 0.002 vs. group B) and 3/42 became definitive (P = 0.096 vs. group A and P = 0.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P < 0.001).

Conclusions

We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation.

Hu J, Zhao N, Kong R et al (2016) Total thyroidectomy as primary surgical management for thyroid disease: surgical therapy experience from 5559 thyroidectomies in a less-developed region. World J Surg Oncol 14:20. doi:10.1186/s12957-016-0772-1 CrossRefPubMedPubMedCentral

Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73:761–768CrossRefPubMed

Palazzo FF, Sywak MS, Sidhu SB et al (2005) Parathyroid autotransplantation during total thyroidectomy—Does the number of glands transplanted affect outcome? World J Surg 29:629–631. doi:10.1007/s00268-005-7729-9 CrossRefPubMed

Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724. doi:10.1007/s002689900459 CrossRefPubMed

Bhattacharyya N, Fried MP (2002) Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 128:389–392CrossRefPubMed

Abboud B, Sargi Z, Akkam M et al (2002) Risk factors for post-thyroidectomy hypocalcemia. J Am Coll Surg 195:456–461CrossRefPubMed

Olson JA, DeBenedetti MK, Baumann DS et al (1996) Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 223:472–478CrossRefPubMedPubMedCentral

Edafe O, Antakia R, Laskar N et al (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101:307–320CrossRefPubMed

Sakorafas GH, Stafyla V, Bramis C et al (2005) Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy. World J Surg 29:1539–1543. doi:10.1007/s00268-005-0032-y CrossRefPubMed

10.

Lo CY (2002) Parathyroid autotransplantation during thyroid surgery. ANZ J Surg 72:902–927CrossRefPubMed

11.

Barczynski M, Cichon S, Konturek A (2007) Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery? Langenbecks Arch Surg 392:693–698CrossRefPubMed

12.

Akerström G, Malmaeus J, Bergström R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMed

13.

Conti Freitas LC, Foss Freitas MC, Lucca LJ et al (2009) Dynamics of parathyroid hormone secretion after total parathyroidectomy and autotransplantation. World J Surg 33:1403–1407. doi:10.1007/s00268-009-0057-8 CrossRefPubMed

14.

Abboud B, Sleilaty G, Braidy C et al (2007) Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery. Arch Otolaryngol Head Neck Surg 133:1105–1110. doi:10.1001/archotol.133.11.1105 CrossRefPubMed

15.

El-Sharaky MI, Kahalil MR, Sharaky O et al (2003) Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy. Head Neck 25:799–807CrossRefPubMed

16.

Thompson NW, Olsen WR, Hoffmann GL (1973) The continuing development of the technique of thyroidectomy. Surgery 73:913–927PubMed

17.

Kihara M, Yokomine H, Miyauchi A et al (2000) Recovery of parathyroid function after total thyroidectomy. Surg Today 30:333–338CrossRefPubMed

18.

Kihara M, Miyauchi A, Kontani K et al (2005) Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J Surg 75:532–536CrossRefPubMed

19.

Saint Marc O, Cogliandolo A, Piquard A et al (2007) LigaSure vs. clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study. Arch Surg 142:150–156CrossRefPubMed

20.

Sartori PV, De Fina S, Colombo G et al (2008) Ligasure versus Ultracision in thyroid surgery: a prospective randomized study. Langenbecks Arch Surg 393:655–658CrossRefPubMed

21.

Lahey FH (1926) The transplantation of parathyroids in partial thyroidectomy. Surg Gynecol Obstet 62:508–509

22.

Wells SA, Stirman JA, Bolman RM (1977) Parathyroid transplantation. World J Surg 1:747–756. doi:10.1007/BF01555931 CrossRefPubMed

23.

Olson JA, DeBenedetti MK, Baumann DS et al (1996) Parathyroid autotransplantation during thyroid surgery. Results of long term follow-up. Ann Surg 223:472–478CrossRefPubMedPubMedCentral

24.

Lo CY, Lam KY (1998) Postoperative hypocalcaemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery 124:1081–1087CrossRefPubMed

25.

Fama’ F, Cicciu’ M, Giudice GL et al (2015) Pattern of nodal involvement in papillary thyroid cancer: a challenge of quantitative analysis. Int J Clin Exp Pathol 8:11629–11634

26.

Campana FP, Marchesi M, Biffoni M et al (1996) Total thyroidectomy technique: suggestions and proposals of surgical practice. Ann Ital Chir 67:627–635PubMed

27.

Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3660 patients. Langenbecks Arch Surg 393:667–673CrossRefPubMed

28.

Thomusch O, Machens A, Sekulla C et al (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133:180–185CrossRefPubMed

29.

Kiviniemi H, Vornanen T, Makela J (2010) Prevention of complications of thyroid and parathyroid surgery. Duodecim 126:269–275PubMed

30.

Sciumè C, Geraci G, Pisello F et al (2006) Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment. Ann Ital Chir 77:115–122PubMed

31.

Jansson S, Tisell LE (1987) Autotransplantation of diseased parathyroid glands into subcutaneous abdominal adipose tissue. Surgery 101:549–556PubMed

32.

Wells SA, Burdick JF, Ketcham AS et al (1973) Transplantation of the parathyroid glands in dogs. Biochemical, histological, and radioimmunoassay proof of function. Transplantation 15:179–182CrossRefPubMed

33.

Wells SA, Gunnells JC, Shelburne JD et al (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34–44PubMed

34.

Wells SA, Ross AJ, Dale JK et al (1979) Transplantation of the parathyroid glands: current status. Surg Clin North Am 59:167–177CrossRefPubMed

35.

Echenique-Elizondo M, Amondarain JA, Vidaur F et al (2007) Parathyroid subcutaneous pre-sternal transplantation after parathyroidectomy for renal hyperparathyroidism. Long-term graft function. World J Surg 31:1403–1409. doi:10.1007/s00268-007-9092-5 CrossRefPubMed

36.

Yoon JH, Nam KH, Chang HS et al (2006) Total parathyroidectomy and autotransplantation by the subcutaneous injection technique in secondary hyperparathyroidism. Surg Today 36:304–307CrossRefPubMed

37.

Conzo G, Della Pietra C, Tartaglia E et al (2014) Long-term function of parathyroid subcutaneous autoimplantation after presumed total parathyroidectomy in the treatment of secondary hyperparathyroidism. A clinical retrospective study. Int J Surg 12:S165–S169CrossRefPubMed

38.

Tan CC, Cheah WK, Tan CT et al (2010) Intramuscular injection of parathyroid autografts is a viable option after total parathyroidectomy. World J Surg 34:1332–1336. doi:10.1007/s00268-010-0531-3 CrossRefPubMed

39.

Pitt SC, Sippel RS, Chen H (2009) Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am 89:1227–1239CrossRefPubMedPubMedCentral

40.

Schneider R, Slater EP, Karakas E et al (2012) Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg 36:318–326. doi:10.1007/s00268-011-1392-0 CrossRefPubMed

41.

Ahmed N, Aurangzeb M, Muslim M et al (2013) Routine parathyroid autotransplantation during total thyroidectomy: a procedure with predictable outcome. J Pak Med Assoc 63:190–193PubMed

42.

Abd Elmaksoud AE, Farahat IG, Kamel MM (2015) Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: a case series. Ann Med Surg (Lond) 4:85–88CrossRef

43.

He Q, Zhuang D, Zheng L et al (2014) Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience. BMC Surg 14:26CrossRefPubMedPubMedCentral

44.

Cohen MS, Dilley WG, Wells SA et al (2005) Long-term functionality of cryopreserved parathyroid autografts: a 13-year prospective analysis. Surgery 138:1033–1040CrossRefPubMed

45.

Zedenius J, Wadstrom C, Delbridge L (1999) Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero. ANZ J Surg 69:794–797CrossRef

46.

Hallgrimsson P, Nordenström E, Almquist M et al (2012) Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1157 patients. World J Surg 36:1933–1942. doi:10.1007/s00268-012-1574-4 CrossRefPubMed

47.

Lang BH, Yih PC, Ng KK (2012) A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 36:1300–1306. doi:10.1007/s00268-012-1561-9 CrossRefPubMedPubMedCentral

48.

Promberger R, Ott J, Kober F et al (2010) Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid 20:1371–1375CrossRefPubMed

49.

Asari R, Passler C, Kaczirek K et al (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143:132–137CrossRefPubMed

50.

Di Fabio F, Casella C, Bugari G et al (2006) Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH. World J Surg 30:1428–1433. doi:10.1016/j.ijsu.2008.12.029 CrossRefPubMed

51.

Roh JL, Park JY, Park CI (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 245:604–610CrossRefPubMedPubMedCentral

52.

Cavicchi O, Piccin O, Caliceti U et al (2007) Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg 137:654–658CrossRefPubMed

53.

Paek SH, Lee YM, Min SY et al (2013) Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg 37:94–101. doi:10.1007/s00268-012-1809-4 CrossRefPubMed

54.

Sitges-Serra A, Ruiz S, Girvent M et al (2010) Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 97:1687–1695CrossRefPubMed

55.

Tartaglia F, Blasi S, Giuliani A et al (2015) Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg 28:S79–S83CrossRefPubMed

56.

Cavallaro G, Iorio O, Centanni M et al (2015) Parathyroid reimplantation in forearm subcutaneous tissue during thyroidectomy: a simple and effective way to avoid hypoparathyroidism. World J Surg 39:1936–1942. doi:10.1007/s00268-015-3070-0 CrossRefPubMed

57.

Abboud B, Sargi Z, Akkam M et al (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195:456–461CrossRefPubMed

58.

Tartaglia F, Giuliani A, Sgueglia M et al (2005) Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy. Am J Surg 190:424–429CrossRefPubMed

59.

Tartaglia F, Sgueglia M, Muhaya A et al (2003) Complications in total thyroidectomy: our experience and a number of considerations. Chir Ital 55:499–510PubMed

60.

Peparini N, Maturo A, Di Matteo FM et al (2006) Blue-dye sentinel node mapping in thyroid carcinoma: debatable results of feasibility. Acta Chir Belg 106:523–527CrossRefPubMed

Title: Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution
Authors: Fausto Famà
Marco Cicciù
Francesca Polito
Antonio Cascio
Maria Gioffré-Florio
Arnaud Piquard
Olivier Saint-Marc
Alessandro Sindoni
Publication date: 01-02-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 2/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3754-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Robotic Site Adjusted Levator Transection for Carcinoma of the Rectum: A Modification of the Existing Cylindrical Abdominoperineal Resection for Eccentrically Located Tumors

Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC)

The Quality and Utility of Surgical and Anesthetic Data at a Ugandan Regional Referral Hospital

Effects of Topical Atorvastatin (2 %) on Posthemorrhoidectomy Pain and Wound Healing: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Surgery-Related Muscle Loss and Its Association with Postoperative Complications After Major Hepatectomy with Extrahepatic Bile Duct Resection

The Presence of Serum p53 Antibody Predicts the Pathological Tumor Response to Neoadjuvant Chemotherapy with Docetaxel, Cisplatin and Fluorouracil (DCF) in Esophageal Squamous Cell Carcinoma