P Casper Smit, Inne H M Borel Rinkes, et al (The Department of Surgery and Radiology, University Medical Center Utrecht, the Netherlands)
Direct, Minimally Invasive Adenomectomy for Primary Hyperparathyroidism
An Alternative to Conventional Neck Exploration?
Annals of Surgery, April 2000, 231(4), 559-565.
Primary hyperparathyroidism is usually caused by a solitary adenoma (85%-90% of cases). In such a stituation a direct adenomectomy through a mini incision would theoretically suffice, if the adenoma is accurately localised by radiography. This would avoid an unnecessary bilateral neck dissection.
Between October 1994 and October 1998, 110 consecutive biochemically proven cases of hyperparathyroidism (primary) were enrolled in a study. USG and spinal CT were routinely performed in the first series of 65 patients. In the second series of 45 patients USG was performed as a sole initial modality. It was supplemented by CT in case of inconclusive results. If localisation of the adenoma was unequivocal, a minimally invasive adenomectomy was performed. CNE (Conventional Neck Exploration) was performed if localisation of the adenoma was not certain.
84 cases were subjected to MIA and 26 for CNE. 2 MIA procedures had to be converted to CNE. In the first series (65 cases) all procedures resulted in normocalcaemia. In the second series (45 cases), all but 5 cases resulted in normocalcaemia. Re-exploration (CNE) was done 3 of these failures with good results. Two patients are still awaiting re-exploration. In all 78 of 110 patients benefitted from MIA and were spared CNE.