Minimally invasive parathyroidectomy
- A conventional parathyroidectomy entails bilateral neck exploration, identification of all four glands, and removal of the grossly enlarged gland(s).
- The development of accurate preoperative localization studies and a rapid intraoperative parathyroid hormone (ioPTH) assay has fostered the development of minimally invasive approaches to parathyroidectomy. A focused unilateral approach utilizes preoperative imaging to limit the dissection to one side.
- The abnormal gland is found and removed and after 10 to 15 minutes a postexcision blood sample is drawn and the PTH level is compared with a preexcision blood sample.
- A reduction of the PTH to 50% of the preoperative level and into the normal range predicts successful removal of all hyperfunctioning glands, and the surgery is terminated.
- If the PTH does not drop appropriately, then all four glands must be identified because the patient likely has multiglandular disease.
