Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Surgery
Published in: BMC Surgery 1/2015

Open Access 01-12-2015 | Research article

Autotransplantation of parathyroid grafts into the tibialis anterior muscle after parathyroidectomy: a novel autotransplantation site

Authors: Chrysanthi Anamaterou, Matthias Lang, Simon Schimmack, Gottfried Rudofsky, Markus W. Büchler, Hubertus Schmitz-Winnenthal

Published in: BMC Surgery | Issue 1/2015

Login to get access

Abstract

Background

Surgical management of renal secondary hyperparathyroidism (sHPT) is varying. Total parathyroidectomy with heterotopic autotransplantation (TPTX + AT) is one of the standard surgical procedures in sHPT, but there is no consensus about the optimal site for graft insertion. At the surgical department of the University Hospital of Heidelberg we prefer the autotransplantation into the tibialis anterior muscle. The aim of this study was to assess the long-term function of the auto-transplanted parathyroid tissue in this type of surgical procedure.

Methods

The function of the autograft of 42 patients was assessed 8.2 ± 2.5 years after surgery, using a modified Casanova-test of the leg bearing the parathyroid tissue. Ischemic blockage was induced by tourniquet and the levels of parathyroid hormone (PTH) were assessed during the test.

Results

At the point of assessment, the ischemic blockage led to a significant reduction in the concentration of PTH (≥50 % of the baseline value) in 19 patients (45 %) indicating well-functioning autografts. In 11 patients (26 %), ischemic blockage did not cause any change in the concentration of PTH (≤20 % of the baseline value), indicating functioning residual parathyroid tissue from another site. The source of PTH production was classified as unidentifiable in five patients (12 %). Two patients had developed graft-dependent recurrent HPT (5 %) without therapeutic consequences and three patients suffered from persistent symptomatic hypoparathyroidism (7 %).

Conclusions

These results indicate that TPTX + AT into the tibialis anterior muscle is a successful surgical treatment for renal HPT and that the modified Casanova-test is a suitable diagnostic tool for autografts function.
Literature
1.
Brunkhorst R. Mineral and bone disorder in chronic kidney disease. Critical appraisal of pharmacotherapy. Internist. 2014;55:334–9.CrossRefPubMed
2.
Pitt SC, Sippel RS, Chen H. Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am. 2009;89(5):1227–39.CrossRefPubMedPubMedCentral
3.
Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol. 2012;269(6):1565–76.
4.
Triponez F, Clark OH, Vanrenthergem Y, Evenepoel P. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg. 2008;248(1):18–30.CrossRefPubMed
5.
Riss P, Asari R, Scheuba C, Niederle B. Current trends in surgery for renal hyperparathyroidism (RHPT)--an international survey. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2013;398(1):121–30.CrossRef
6.
Schneider R, Slater EP, Karakas E, Bartsch DK, Schlosser K. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg. 2012;36(2):318–26.CrossRefPubMed
7.
Kiviniemi H, Vornanen T, Makela J. Prevention of complications of thyroid and parathyroid surgery. Duodecim; laaketieteellinen aikakauskirja. 2010;126(3):269–75.PubMed
8.
Sciume C, Geraci G, Pisello F, Facella T, Li Volsi F, Licata A, et al. Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment. Ann Ital Chir. 2006;77(2):115–22.
9.
Jansson S, Tisell LE. Autotransplantation of diseased parathyroid glands into subcutaneous abdominal adipose tissue. Surgery. 1987;101(5):549–56.PubMed
10.
Wells SA, Burdick JF, Ketcham AS, Christiansen C. Transplantation of the parathyroid glands in dogs. Biochemical, histological, and radioimmunoassay proof of function. Transplantation. 1973;15(1):179–82.CrossRefPubMed
11.
Wells Jr SA, Gunnells JC, Shelburne JD, Schneider AB, Sherwood LM. Transplantation of the parathyroid glands in man: clinical indications and results. Surgery. 1975;78(1):34–44.PubMed
12.
Wells Jr SA, Ross 3rd AJ, Dale JK, Gray RS. Transplantation of the parathyroid glands: current status. Surg Clin North Am. 1979;59(1):167–77.CrossRefPubMed
13.
Echenique-Elizondo M, Amondarain JA, Vidaur F, Olalla C, Aribe F, Garrido A, et al. Parathyroid subcutaneous pre-sternal transplantation after parathyroidectomy for renal hyperparathyroidism. Long-term graft function. World J Surg. 2007;31(7):1403–9.
14.
Yoon JH, Nam KH, Chang HS, Chung WY, Park CS. Total parathyroidectomy and autotransplantation by the subcutaneous injection technique in secondary hyperparathyroidism. Surg Today. 2006;36(4):304–7.CrossRefPubMed
15.
Conzo G, Della Pietra C, Tartaglia E, Gambardella C, Mauriello C, Palazzo A, et al. Long-term function of parathyroid subcutaneous autoimplantation after presumed total parathyroidectomy in the treatment of secondary hyperparathyroidism. A Clin Retrospective Study. 2014;12 Suppl 1:S165–9.
16.
Tan CC, Cheah WK, Tan CT, Rauff A. Intramuscular injection of parathyroid autografts is a viable option after total parathyroidectomy. World J Surg. 2010;34(6):1332–6.CrossRefPubMed
17.
Casanova D, Sarfati E, De Francisco A, Amado JA, Arias M, Dubost C. Secondary hyperparathyroidism: diagnosis of site of recurrence. World J Surg. 1991;15(4):546–9. discussion 549–550.CrossRefPubMed
18.
Schlosser K, Sitter H, Rothmund M, Zielke A. Assessing the site of recurrence in patients with secondary hyperparathyroidism by a simplified Casanova autograftectomy test. World J Surg. 2004;28(6):583–8.CrossRefPubMed
19.
Knudsen L, Brandi L, Daugaard H, Olgaard K, Lockwood K. Five to 10 years follow-up after total parathyroidectomy and autotransplantation of parathyroid tissue: evaluation of parathyroid function by use of ischaemic blockade manoeuvre. Scand J Clin Lab Invest. 1996;56(1):47–51.CrossRefPubMed
20.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1.
21.
Lahey. The transplantation of parathyroids in partial thyroidectomy. Surg Gynecol Obstet. 1926;62:508–9.
22.
Gagne ER, Urena P, Leite-Silva S, Zingraff J, Chevalier A, Sarfati E, et al. Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol. 1992;3(4):1008–17.
23.
Dotzenrath C, Cupisti K, Goretzki E, Mondry A, Vossough A, Grabensee B, et al. Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie. 2003;387(9–10):348–54.
24.
Hampl H, Steinmuller T, Stabell U, Klingenberg HJ, Schnoy N, Neuhaus P. Recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis. Miner Electrolyte Metab. 1991;17(4):256–60.PubMed
25.
Low TH, Clark J, Gao K, Eris J, Shannon K, O’Brien C. Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidism. ANZ J Surg. 2009;79(5):378–82.CrossRefPubMed
26.
Blomme RA, Blomme AM, Rinkes IH, Meerwaldt R, van der Wal MB, Valk GD, et al. Surgical strategy in patients with secondary and tertiary hyperparathyroidism. A bi-institutional series. Acta Chir Belg. 2010;110(1):35–9.
27.
Niederle B, Horandner H, Roka R, Woloszczuk W. Parathyroidectomy and autotransplantation in renal hyperparathyroidism. II. Morphologic and functional studies in transplant-dependent recurrence. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 1989;60(10):671–7.PubMed
28.
He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, et al. Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience. BMC Surg. 2014;14(1):26.
29.
Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg. 2001;233(1):65–9.CrossRefPubMedPubMedCentral
30.
Tominaga Y, Matsuoka S, Uno N, Tsuzuki T, Hiramitsu T, Goto N, et al. Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg. 2010;34(6):1312–7.
31.
Sadideen HM, Taylor JD, Goldsmith DJ. Total parathyroidectomy without autotransplantation after renal transplantation for tertiary hyperparathyroidism: long-term follow-up. Int Urol Nephrol. 2012;44(1):275–81.CrossRefPubMed
32.
Walgenbach S, Hommel G, Junginger T. Prospective evaluation of parathyroid graft function after total parathyroidectomy and heterotopic autotransplantation in renal hyperparathyroidism by bilateral determination of intact parathormone in cubital venous blood. World J Surg. 1998;22(1):93–7. discussion 97–98.CrossRefPubMed
33.
Lo CY, Tam SC. Parathyroid autotransplantation during thyroidectomy: documentation of graft function. Arch Surg. 2001;136(12):1381–5.CrossRefPubMed
34.
Herrera M, Grant C, van Heerden JA, Fitzpatrick LA. Parathyroid autotransplantation. Arch Surg. 1992;127(7):825–9. discussion 829–830.CrossRefPubMed
35.
Feldman AL, Sharaf RN, Skarulis MC, Bartlett DL, Libutti SK, Weinstein LS, et al. Results of heterotopic parathyroid autotransplantation: a 13-year experience. Surgery. 1999;126(6):1042–8.
36.
Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002;62(4):1109–24.CrossRefPubMed
37.
Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman-Breen CO. Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study. J Vasc Surg. 2001;34(4):694–700.CrossRefPubMed
38.
Gibson KD, Caps MT, Kohler TR, Hatsukami TS, Gillen DL, Aldassy M, et al. Assessment of a policy to reduce placement of prosthetic hemodialysis access. Kidney Int. 2001;59(6):2335–45.
39.
Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59–64.
Metadata
Title
Autotransplantation of parathyroid grafts into the tibialis anterior muscle after parathyroidectomy: a novel autotransplantation site
Authors
Chrysanthi Anamaterou
Matthias Lang
Simon Schimmack
Gottfried Rudofsky
Markus W. Büchler
Hubertus Schmitz-Winnenthal
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2015
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-015-0098-x

Other articles of this Issue 1/2015

BMC Surgery 1/2015 Go to the issue

Study protocol

BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial

Research article

Surgical evolution in the treatment of mandibular condyle fractures

Case report

Nonfunctional adrenocortical carcinoma initially presenting as retroperitoneal hemorrhage

Research article

Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours

Research article

The TICAP-Study (titanium clips for appendicular stump closure): A prospective multicentre observational study on appendicular stump closure with an innovative titanium clip

Case report

Simplified technique of laparoscopic cholecystectomy in a patient with situs inversus: a case report and review of techniques