TY  - JOUR
T1  - Directed parathyroidectomy: Feasibility and performance in 100 consecutive patients with primary hyperparathyroidism
AU  - Burkey SH, Snyder WH, III, Nwariaku F, Watumull L, Mathews D
Y1  - 2003/06/01
N1  - 10.1001/archsurg.138.6.604
JO  - Archives of Surgery
SP  - 604
EP  - 609
VL  - 138
IS  - 6
N2  - Hypothesis 
    Directed parathyroidectomy (DP) can be successfully completed in most patients with primary hyperparathyroidism.Design and Setting 
    Retrospective review at a tertiary referral center.Patients 
    One hundred consecutive patients with untreated, sporadic primary hyperparathyroidism operated on by a single surgeon from April 1, 1999, through December 31, 2001.Interventions 
    Following preoperative imaging with sestamibi scintigraphy and ultrasonography, patients underwent parathyroidectomy with intraoperative parathyroid hormone monitoring using a focused approach through a limited neck incision (DP) or bilateral neck exploration (BNE) through a standard collar incision.Main Outcome Measures 
    Extent of exploration, operative time, length of stay, morbidity, and cure.Results 
    Directed parathyroidectomy was completed in 70 patients and BNE in 30. Bilateral neck exploration was performed as the initial procedure in 13 patients and following intraoperative conversion from attempted DP in 17. Indications for predetermined BNE were failed preoperative localization (n = 8) and concomitant thyroid disease that required operative treatment (n = 5). The need for predetermined BNE decreased as preoperative localization improved. Intraoperative factors that necessitated conversion to BNE included persistently elevated intraoperative parathyroid hormone levels that accurately predicted multiglandular disease (n = 6), incorrect localization (n = 5), and inadequate exposure (n = 6). Operative time and length of stay were less for DP compared with BNE patients (66 vs 165 minutes and 0.5 vs 1.6 days, respectively). One patient had a temporary vocal cord paresis. All patients were eucalcemic in follow-up (4 months to 3 years).Conclusions 
    With accurate preoperative localization and intraoperative parathyroid hormone monitoring, DP can be successfully completed in most patients with sporadic primary hyperparathyroidism. Patients benefit from DP, which reduces operative time and length of stay and facilitates rapid convalescence.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.138.6.604
UR  - http://dx.doi.org/10.1001/archsurg.138.6.604
ER  -