Ambulatory parathyroidectomy for primary hyperparathyroidism

George L. Irvin, George Sfakianakis, Luke Yeung, George T. Deriso, Lawrence M. Fishman, Alberto S. Molinari, Joseph N. Foss

Research output: Contribution to journalArticle

202 Scopus citations

Abstract

Objectives: To evaluate whether the combined application of preoperative localization and intraoperative monitoring of intact parathyroid hormone (iPTH) levels could facilitate sate outpatient parathyroidectomy. Design: Consecutive patients, who had no antecedent social or medical conditions mandating hospitalization, were prospectively offered ambulatory parathyroidectomy with a mean follow-up of 7 months (range, 1-25 months). Setting: Tertiary care referral center. Patients: From 85 patients who had primary hyperparathyroidism with hypercalcemia and elevated iPTH levels, 57 were offered outpatient parathyroidectomy. Nineteen patients were asymptomatic, 3 had hypercalcemic crisis, and the others gave a history of renal stones or had complaints consistent with bone disease. Interventions: Technetium Tc 99m sestamibi scintiscans were used for preoperative localization. Monitoring iPTH levels during parathyroidectomy quantitatively assured the surgeon (G.L.I. only) when all hyperfunctioning glands were excised. Main Outcome Measure: The number of patients with out complications and with short operative times who were discharged without hospital admission or over night stay. Results: The combination of preoperative localization of abnormal parathyroid glands and a decline in circulating iPTH levels predicting postoperative normocalcemia after excision of all hyperfunctioning glands resulted in successful parathyroidectomy in 84 of 85 patients. A decreased operative time (average, 52 minutes) with minimal neck dissection permitted outpatient parathyroidectomy in 42 of 57 eligible patients. Conclusions: The combination of preoperative parathyroid scintiscan localization and iPTH level monitoring during surgery, permitted successful parathyroidectomy in an ambulatory setting in half of a consecutive series of patients with primary hyperparathyroidism. The safety, success, and likely cost savings of this approach suggest wider application.

Original languageEnglish (US)
Pages (from-to)1074-1078
Number of pages5
JournalArchives of Surgery
Volume131
Issue number10
DOIs
StatePublished - Oct 1996

ASJC Scopus subject areas

  • Surgery

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    Irvin, G. L., Sfakianakis, G., Yeung, L., Deriso, G. T., Fishman, L. M., Molinari, A. S., & Foss, J. N. (1996). Ambulatory parathyroidectomy for primary hyperparathyroidism. Archives of Surgery, 131(10), 1074-1078. https://doi.org/10.1001/archsurg.1996.01430220068015