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Outpatient Parathyroidectomy

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Medical and Surgical Treatment of Parathyroid Diseases

Abstract

Most cases of primary hyperparathyroidism are caused by a single parathyroid adenoma. Minimally invasive parathyroidectomy for parathyroid adenomas can be performed in the outpatient setting; patients are typically discharged from the recovery room within hours after surgery if they meet discharge criteria. This chapter reviews the concept of outpatient parathyroidectomy, optimal preoperative localization algorithms, patient selection criteria, technical surgical aspects, and safety and outcomes of outpatient parathyroidectomy.

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References

  1. Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992;215(4):300–17. Clinical Review; Level 2; Grade C.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Russell CF, Dolan SJ, Laird JD. Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg. 2006;93(4):418–21. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  3. Russell CF, Laird JD, Ferguson WR. Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach? World J Surg. 1990;14(3):406–9. Clinical Investigation; Level 2; Grade B.

    Article  CAS  PubMed  Google Scholar 

  4. Hsi ED, Zukerberg LR, Yang WI, Arnold A. Cyclin D1/PRAD1 expression in parathyroid adenomas: an immunohistochemical study. J Clin Endocrinol Metab. 1996;81(5):1736–9. Basic Science. Level 1; Grade A.

    CAS  PubMed  Google Scholar 

  5. Rosenberg CL, Kim HG, Shows TB, Kronenberg HM, Arnold A. Rearrangement and overexpression of D11S287E, a candidate oncogene on chromosome 11q13 in benign parathyroid tumors. Oncogene. 1991;6(3):449–53. Basic Science Review; Level 1; Grade B.

    CAS  PubMed  Google Scholar 

  6. Vasef MA, Brynes RK, Sturm M, Bromley C, Robinson RA. Expression of cyclin D1 in parathyroid carcinomas, adenomas, and hyperplasias: a paraffin immunohistochemical study. Mod Pathol. 1999;12(4):412–6. Basic Science; Level 1; Grade A.

    CAS  PubMed  Google Scholar 

  7. Arnold A, Shattuck TM, Mallya SM, Krebs LJ, Costa J, Gallagher J, Wild Y, Saucier K. Molecular pathogenesis of primary hyperparathyroidism. J Bone Miner Res. 2002;17 Suppl 2:N30–6. Basic Science Review; Level 1; Grade B.

    CAS  PubMed  Google Scholar 

  8. Heppner C, Kester MB, Agarwal SK, Debelenko LV, Emmert-Buck MR, Guru SC, Manickam P, Olufemi SE, Skarulis MC, Doppman JL, Alexander RH, Kim YS, Saggar SK, Lubensky IA, Zhuang Z, Liotta LA, Chandrasekharappa SC, Collins FS, Spiegel AM, Burns AL, Marx SJ. Somatic mutation of the MEN1 gene in parathyroid tumours. Nat Genet. 1997;16(4):375–8. Basic Science Review; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  9. Sosa JA, Udelsman R. Minimally invasive parathyroidectomy. Surg Oncol. 2003;12(2):125–34. Clinical Review; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  10. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253(3):585–91. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  11. Phillips CD, Shatzkes DR. Imaging of the parathyroid glands. Semin Ultrasound CT MR. 2012;33(2):123–9. Clinical Review; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  12. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577–83. Clinical Review; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  13. Hetrakul N, Civelek AC, Stagg CA, Udelsman R. In vitro accumulation of technetium-99m-sestamibi in human parathyroid mitochondria. Surgery. 2001;130(6):1011–8. Basic Science Review; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  14. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med. 2005;35(4):266–76. Clinical Review; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  15. Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, Scheidhauer K, Wester HJ, Rummeny EJ, Schwaiger M, Drzezga A. SPECT/CT. J Nucl Med. 2008;49(8):1305–19. Basic Science Review; Level I; Grade B.

    Article  PubMed  Google Scholar 

  16. Lal A, Chen H. The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible? Ann Surg Oncol. 2007;14(8):2363–6. Clinical Review; Level 3, Grade C.

    Article  PubMed  Google Scholar 

  17. Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery. 2002;131(2):149–57. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  18. Bahl M, Sepahdari AR, Sosa JA, Hoang JK. Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 2015;29:142393. Clinical Review; Level 3; Grade A.

    Google Scholar 

  19. Lopez Hanninen E, Vogl TJ, Steinmuller T, Ricke J, Neuhaus P, Felix R. Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism. Invest Radiol. 2000;35(7):426–30. Clinical Review; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  20. Wakamatsu H, Noguchi S, Yamashita H, Yamashita H, Tamura S, Jinnouchi S, Nagamachi S, Futami S. Parathyroid scintigraphy with 99mTc-MIBI and 123I subtraction: a comparison with magnetic resonance imaging and ultrasonography. Nucl Med Commun. 2003;24(7):755–62. Clinical Investigation; Level 2; Grade B.

    Article  CAS  PubMed  Google Scholar 

  21. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. Would scan, but which scan? A cost-utility analysis to optimize preoperative imaging for primary hyperparathyroidism. Surgery. 2011;150(6):1286–94. Clinical Investigation; Level 2; Grade A.

    Article  PubMed  Google Scholar 

  22. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561–9. Clinical Review; Level 2; Grade A.

    Article  CAS  PubMed  Google Scholar 

  23. Perrier ND. Asymptomatic hyperparathyroidism: a medical misnomer? Surgery. 2005;137(2):127–31. Clinical Review; Level 5.

    Article  PubMed  Google Scholar 

  24. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005;140(5):472–8. discussion 478–9. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  25. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002;236(5):543–51. Clinical Investigation; Level 1; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Black MJ, Ruscher AE, Lederman J, Chen H. Local/cervical block anesthesia versus general anesthesia for minimally invasive parathyroidectomy: what are the advantages? Ann Surg Oncol. 2007;14(2):744–9. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  27. Carneiro DM, Irvin III GL. Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. Surgery. 2000;128(6):925–9;discussion 935–26. Clinical Investigation; Level 2; Grade B.

    Article  CAS  PubMed  Google Scholar 

  28. Carneiro DM, Solorzano CC, Irvin 3rd GL. Recurrent disease after limited parathyroidectomy for sporadic primary hyperparathyroidism. J Am Coll Surg. 2004;199(6):849–53. discussion 853–845. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  29. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin 3rd GL. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003;134(6):973–9. discussion 979–81. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  30. Irvin 3rd GL, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg. 2004;239(5):704–8. discussion 708–11. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Irvin III GL, Molinari AS, Figueroa C, Carneiro DM. Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg. 1999;229(6):874–8. discussion 878–9. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Thier M, Nordenstrom E, Bergenfelz A, Westerdahl J. Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy--a feasibility study. Langenbecks Arch Surg. 2009;394(5):881–4. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  33. Dixon JL, Snyder SK, Lairmore TC, Jupiter D, Govednik C, Hendricks JC. A novel method for the management of post-thyroidectomy or parathyroidectomy hematoma: a single-institution experience after over 4,000 central neck operations. World J Surg. 2014;38(6):1262–7. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  34. Schneider DF, Mazeh H, Chen H, Sippel RS. Predictors of recurrence in primary hyperparathyroidism: an analysis of 1386 cases. Ann Surg. 2014;259(3):563–8. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Stack Jr BC, Spencer H, Moore E, Medvedev S, Bodenner D. Outpatient parathyroid surgery data from the University Health System Consortium. Otolaryngol Head Neck Surg. 2012;147(3):438–43. Population Study; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  36. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235(5):665–70. discussion 670–62. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012;152(6):1008–15. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kebebew E, Duh QY, Clark OH. Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a plea for early surgical referral. Arch Surg. 2003;138(8):867–71. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  39. Thomas DC, Roman SA, Sosa JA. Parathyroidectomy in the elderly: analysis of 7313 patients. J Surg Res. 2011;170(2):240–6. Population Study; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  40. Politz D, Norman J. Hyperparathyroidism in patients over 80: clinical characteristics and their ability to undergo outpatient parathyroidectomy. Thyroid. 2007;17(4):333–9. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  41. Shin SH, Holmes H, Bao R, Jimenez C, Kee SS, Potylchansky E, Lee JE, Evans DB, Perrier ND. Outpatient minimally invasive parathyroidectomy is safe for elderly patients. J Am Coll Surg. 2009;208(6):1071–6. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  42. Pitt SC, Panneerselvan R, Sippel RS, Chen H. Influence of morbid obesity on parathyroidectomy outcomes in primary hyperparathyroidism. Am J Surg. 2010;199(3):410–4. discussion 414–5. Clinical Investigation; Level 2; Grade B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Norman J, Aronson K. Outpatient parathyroid surgery and the differences seen in the morbidly obese. Otolaryngol Head Neck Surg. 2007;136(2):282–6. Clinical Investigation; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  44. Buerba R, Roman SA, Sosa JA. Thyroidectomy and parathyroidectomy in patients with high body mass index are safe overall: analysis of 26,864 patients. Surgery. 2011;150(5):950–8. Population Study; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  45. Udelsman R, Akerstrom G, Biagini C, Duh QY, Miccoli P, Niederle B, Tonelli F. The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3595–606. Clinical Review; Level 2; Grade A.

    Article  CAS  PubMed  Google Scholar 

  46. Starker LF, Akerström T, Long WD, Delgado-Verdugo A, Donovan P, Udelsman R, Lifton RP, Carling T. Frequent germ-line mutations of the MEN1, CASR, and HRPT2/CDC73 genes in young patients with clinically non-familial primary hyperparathyroidism. Horm Cancer. 2012;3(1-2):44–51. Basic Science Review; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Julie A. Sosa M.D., M.A. .

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Adam, M.A., Roman, S.A., Sosa, J.A. (2017). Outpatient Parathyroidectomy. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_37

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  • DOI: https://doi.org/10.1007/978-3-319-26794-4_37

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-26794-4

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