Total Parathyroidectomy and Autotransplantation by Subcutaneous Injection Technique in Renal Hyperparathyroidism

ABSTRACT

PURPOSE: Total parathyroidectomy and forearm intramuscular autotransplantation (Wells' method) is currently widely accepted procedure for renal hyperparathyroidism because it is far easier to deal with in the case of a recurrence, caused by the autotransplanted tissue. The Wells method, however, is somewhat complex and time-consuming. We developed a simple, easy, and non-surgical injection technique for autografting parathyroid tissue into the forearm subcutaneous layer. This study was performed to evaluate the feasibility of this new method and to document the biochemical function of the parathyroid tissue that was autografted using the subcutaneous injection technique. METHODS: The new method was applied to 14 patients with renal hyperparathyroidism, and the short-term operative results, 4 months after surgery, were evaluated in terms of biochemical parameters such as calcium, inorganic phosphorus, intact PTH and alkaline phosphatase. The graft "uptake" was judged by a significant intact PTH ratio (>1.5) between the antecubital vein blood from the grafted and non-grafted arms. RESULTS: Biochemical parameters were normalized in all patients during the postoperative 4 months. All of the grafted parathyroid tissues were functional. In these patients with the graft "uptake", a significant intact PTH ratio (>1.5) between the grafted and non-grafted arms was demonstrated at 2 weeks post operation. A maximal intact PTH gradient was reached at 4 weeks post operation, and the biochemical function persisted in all patients at 4 months post operation. CONCLUSION: This study suggests that total parathyroidectomy and forearm autotransplantation by subcutaneous injection technique can be an alternative to the Wells' method in the surgical treatment of secondary hyperparathyroidism.