Minimally invasive video-assisted parathyroidectomy (MIVAP) using primary hyperparathyroidism therapy (pHPT)
Authors:
B. Dudešek 1; J. Gatěk 1; J. Lukáš 2; A. Kratka 1; J. Duben 1
Authors‘ workplace:
Chirurgické oddělení nemocnice Atlas a. s. Zlín, Univerzita T. Bati ve Zlíně
primář: MUDr. J. Gatěk, Ph. D.
1; Nemocnice Na Homolce, oddělení otorinolaryngologie a chirurgie hlavy a krku
primář: Prof. MUDr. J. Astl, CSc.
2
Published in:
Rozhl. Chir., 2013, roč. 92, č. 12, s. 699-702.
Category:
Original articles
Overview
Introduction:
Primary hyperparathyroidism (pHPT) is a general calcium, phosphate and bone metabolism malfunction due to increased secretion of the parathyroid hormone over a substantial period of time. Causal treatment is a surgical procedure – parathyroidectomy.
Material and methods:
A retrospective study of patients who underwent surgery was conducted in the department of surgery at the Atlas Hospital in Zlín between 2005 and 2011. In this period, 2555 patients were operated on for thyroid and parathyroid gland disease. 182 of these patients (7.1%) had hyperparathyroidism. There were 80 standard parathyroidectomies, 82 MIVAPs and 20 MIRPs (minimally invasive radio-guided parathyroidectomy).
Results:
In the study, 82 patients were operated on using the MIVAP technique. 78 (95.1%) had a parathyroid adenoma, 2 (2.4%) had hyperplasia, 2 (2.4%) had a standard body. Using the MIVAP technique, 75 parathyroid gland adenomas were found in 72 patients, 3 patients (3.6%) had a double adenoma. Conversion was performed in 10 patients (12.2%). During standard revision, an adenoma was found intraparenchymatously in 4 cases (4.9%), in 2 cases the adenoma was removed during standard revision. There was no permanent NRL paresis. 4 patients (4.9%) experienced temporary NLR paresis, MIVAP was successful in 72 patients (87.8%), 6 adenomas were removed during conversion; currently, all these patients have normal levels of calcium and parathyroid hormone. No parathyroid gland adenoma was found in 2 patients (2.4%), nor was it removed using persistent pHPT. 2 patients (2.4%) with hyperplasia are being monitored for their borderline calcium and parathyroid hormone levels.
Conclusion:
MIVAP is a complex endoscopic technique which can achieve 90% success rate in patients with the location of a parathyroid gland adenoma confirmed both by ultrasound and MIBI scanning.
Key words:
pHPT – ultrasound – MIBI – adenoma – MIVAP
Sources
1. Broulík P. Poruchy kalciofosfátového metabolismu. Praha, Grada 2003.
2. Adámek S, Naňka O. Primární hyperparathyreóza. Praha, Galen 2006.
3. Rothmund M. Endokrine Chirurgie (Praxis der Viszeralchirurgie) Heidelberg, Springer 2007.
4. Lorenz K, Dralle H. Chirurgie des Hyperparathyreoidismus Chirurg 2003;74:593–616.
5. Spelsberg F. Peller-Sautter, RH. Operative Technik beim primären Hyperparathyreoidismus. Chirurg 1999;70:1102–1112.
6. Lorenz K, Nguyen-Thanh P, Dralle H. Unilateral open and minimaly invasive procedures for primary hyperparathyroidism: a review selective approaches, Langenbeckęs Arch Surg 2000;385:106–117.
7. Lorenz K, Dralle H. Intraoperative Parathormonbestimmung beim primären Hyperparathyreoidismus. Chirurg 2010;71:636–642.
8. Dudesek B. Gatěk J, Duben J, et al. Miniinvazivní radiačně navigovaná paratyreoidektomie – MIRP. Rozhl Chir 2004;83: 498–502.
9. Undelsman R. Six Hundred Fifty-Six Consecutive Explorations for Primary Hyperparathyroidism. Annals of Surgery 2002;235: 665–672.
10. Friling A, Görges R, Clauer U, Tecklenborg K, Broelsch CC. Minimal-invasive Parathyreoidektomie in Lokalanaesthesie in Verbindung mit Ultrasonographie, Sestamibi-Szintigraphie und intraoperativer Parathormonmessung. Chirurg 2000;71:1474–1479.
11. Libánský P, Tvrdoň J, Broulík P, Kubinyi J, Fialová M, et al. Opakované operace pro karcinom příštítného tělíska. Rozhl Chir 2012;91:601–607.
12. Linhartová M, Mitáč L. Starý K, Munteanu H. Výtěžnost pooperační ultrasonografie v chirurgii příštítných tělísek. Rozhl Chir 2012;91:614–619.
13. Hermann M. Postoperative normokalzämische Hyperparathyreonämie nach kurativer Parathyreoidektomie eines primären Hyperparathyreoidismus. Chirurg 2010;81:447–453.
14. Miccoli P, Berti P, Conte M, Raffaelli M, Materazzi G. Minimally invasive video-assisted parathyreoidectomy : lesson learned from 137 cases. Am J Surg 2000;19:613–618.
15. Miccoli P, Beri P, Materazzi G, Donatini G. Minimally invasive video assisted parathyreoidectomy (MIVAP). Eur J Surg Oncol 2003;29:188–190.
16. Beregnfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyreoidism: a prospective randomized controlled trial. Ann Surg 2002;236: 543–551.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2013 Issue 12
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