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Ambulatory Parathyroidectomy for Primary Hyperparathyroidism

George L. Irvin III, MD; George Sfakianakis, MD; Luke Yeung, MD; George T. Deriso; Lawrence M. Fishman, MD; Alberto S. Molinari, MD; Joseph N. Foss, MD
Arch Surg. 1996;131(10):1074-1078. doi:10.1001/archsurg.1996.01430220068015.
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Objective:  To evaluate whether the combined application of preoperative localization and intraoperative monitoring of intact parathyroid hormone (iPTH) levels could facilitate safe 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 without complications and with short operative times who were discharged without hospital admission or overnight 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.Arch Surg. 1996;131:1074-1078


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