Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach |
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Authors: | Antonio Sitges-Serra Prieto Rosa Mónica Valero Estela Membrilla Joan J Sancho |
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Institution: | (1) Department of Surgery, Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain;(2) Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain |
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Abstract: | Introduction Sporadic primary hyperparathyroidism is due to single adenoma in over 90–95% of instances. Careful medical history and precise
preoperative identification of the enlarged gland by parathyroid Tc-mibi scintigraphy and neck ultrasound allow selecting
patients for minimally invasive parathyroidectomy, a focused intervention with minimal skin opening and tissue dissection.
Small (<300 mg) adenomas continue to challenge preoperative imaging, and most of them will still require a bilateral exploration.
Conclusion Surgery should never be indicated on the basis of positive or negative preoperative localization studies. Intraoperative quick
parathyroid hormone measurements seem particularly helpful for cases with equivocal localization studies. The best minimal
access approach is still a matter of debate, and options include small central incision, video-assisted parathyroidectomy,
minimal lateral open approach, and purely endoscopic access via lateral approach. Radioguided surgery does not seem to have
a role in routine cases but may be useful to find adenomas during reintervention on scarred difficult surgical fields. |
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Keywords: | Parathyroid adenoma Focused parathyroidectomy Controversies Gamma probe Endoscopy Hyperparathyroidism |
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