Minimally Invasive Parathyroidectomy without an Intraoperative i-PTH Test for Patients with Primary Hyperparathyroidism

ABSTRACT

PURPOSE: The aim of this retrospective study was to analyze the outcomes of minimally invasive parathyroidectomy without an intraoperative i-PTH test for the patients with primary hyperparathyroidism. METHODS: We analyzed a total of 179 patients with sporadic primary hyperparathyroidism and who underwent parathyroidectomy at ASAN Medical Center between February 1996 and September 2007. Minimally invasive parathyroidectomy without an intraoperative i-PTH test was performed in 75 patients under the guidance of a preoperative localization study that suggested the presence of single gland disease. Bilateral exploration was performed in 70 patients and unilateral exploration was performed in 34 patients. RESULTS: The success rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test was 98.7%. Postoperative persistent hyperparathyroidism developed in only 1 patient among the 75 patients. The frequency of postoperatively confirmed single gland disease and multigland disease was 92.8% (166 patients) and 7.2% (13 patients), respectively. However, for most of the patients with multiglandular disease (11/13 cases, 84.5%), the possibility of multiglandular disease could be predicted by a preoperative localization study and these patients were excluded from the candidates for performing minimally invasive parathyroidectomy without an intraoperative i-PTH test. For cases that the preoperative localization study suggested single lesion, the frequency of multiglandular disease in those patients who underwent bilateral exploration was relatively low (2.7%, 1/38 cases). CONCLUSION: Selected patients with primary hyperparathyroidism can be successfully managed with minimally invasive parathyroidectomy and without an intraoperative i-PTH test when the preoperative localization study suggests the presence of single gland disease. However, careful evaluation of the preoperative localization study is mandatory to minimize the failure rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test.