Elsevier

Surgery

Volume 138, Issue 4, October 2005, Pages 583-590
Surgery

Central Surgical Association
Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy

https://doi.org/10.1016/j.surg.2005.06.046Get rights and content

Background

Intraoperative parathyroid hormone (iPTH) testing often is used during minimally invasive parathyroidectomy for primary hyperparathyroidism (1°HPT). However, several investigators report that these assays are not cost effective and do not improve outcomes significantly.

Methods

To determine the impact of iPTH testing on the outcomes of patients with 1°HPT, we reviewed our experience. From January 1990 to June 2004, there were 345 consecutive patients with 1°HPT and positive localization studies for a single parathyroid adenoma who were candidates for minimally invasive parathyroidectomy. Group 1 patients (n = 157) underwent parathyroid exploration without iPTH testing and group 2 patients (n = 188) had an operation with iPTH testing.

Results

Of the group 1 patients, 15 (10%) still were hypercalcemic postoperatively owing to additional unidentified hyperfunctioning parathyroid glands. In contrast, among 188 group 2 patients, 170 (90%) had resection of a single parathyroid adenoma, a greater than 50% decrease in iPTH levels, and were cured. The remaining 18 (10%) patients did not have an adequate reduction in iPTH levels and underwent bilateral neck exploration with resection of additional parathyroids. Of these 18 patients, 9 had double adenomas and 9 had 3- or 4-gland hyperplasia. Importantly, all patients in group 2 were cured.

Conclusions

iPTH testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. iPTH testing allowed intraoperative recognition and resection of additional hyperfunctioning parathyroids missed by preoperative imaging studies. Consequently, we strongly advocate the routine use of iPTH testing in patients who undergo minimally invasive parathyroidectomy for 1°HPT.

Section snippets

Patients and methods

Between January 1990 and June 2004 there were 345 consecutive patients with 1°HPT and positive parathyroid localization studies for a single parathyroid adenoma who underwent neck exploration at the University of Wisconsin. On March 1, 2001, iPTH testing became available for clinical use at our institution. Subsequent to that date, all patients undergoing parathyroidectomy had iPTH testing during their operation.

During minimally invasive parathyroidectomy, our protocol for iPTH testing and

Preoperative data

The mean age of all 345 patients was 60 ± 3 years. The mean preoperative laboratory values included serum calcium concentrations of 11.3 ± 0.5 mg/dL and serum phosphorus concentrations of 2.7 ± 0.1 mg/dL. The mean preoperative serum intact PTH level was 150 ± 14 pg/mL. The mean preoperative alkaline phosphatase activity was 122 ± 6 mg/dL. We then compared the preoperative laboratory values between groups 1 and 2. As shown in Table I, there were no significant differences in age or preoperative

Discussion

Minimally invasive parathyroidectomy for 1°HPT is safe and associated with high cure rates in experienced hands.1, 2, 15, 16, 17 As shown by several investigators, minimally invasive parathyroidectomy when compared with bilateral explorations leads to lower hospital costs, shorter durations of stay, a lower incidence of hypocalcemia, and equally high cure rates with low complication rates.3, 4, 5, 7, 17, 18 Several operative adjuncts have been shown to facilitate minimally invasive parathyroid

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  • Cited by (0)

    Presented at the 62nd Annual Meeting of the Central Surgical Association, Tucson, Arizona, March 10-15, 2005.

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