Patient Information on Minimally Invasive Parathyroidectomy

Parathyroid cancer is an uncommon disease; however, many common parathyroid disorders simulate parathyroid cancer, and surgical removal of portions of the parathyroid glands is frequently necessary for diagnosis. This means that many people undergo surgery for a benign problem and acquire an undesirable scar as a result. Fortunately, techniques now exist to minimize or eliminate incisions for parathyroid surgeries.

Page Resources: Development of minimally invasive parathyroid surgery Video-assisted parathyroidectomy Side-by-side surgical comparison

Hyperparathyroidism (elevated parathyroid hormone level) and hypercalcemia (elevated calcium level) are the most common indications for parathyroidectomy (surgical removal on one or more parathyroid glands). The parathyroid glands are located just behind the thyroid gland and are responsible for calcium metabolism. The prevalence of hyperparathyroidism is reported to be approximately 4 cases in 100,000 persons. Primary hyperparathyroidism affects women approximately twice as frequently as men. Prevalence increases with age, but hyperparathyroidism can affect persons of all ages, including children. In rare cases, hyperparathyroidism can be related to a group of familial cancer disorders.

In primary hyperparathyroidism, one gland is released from normal control of the calcium system and begins to overproduce parathyroid hormone. This drives up the blood calcium levels; over time, the bone calcium levels suffer, osteopenia or osteoporosis can develop, and kidney function can suffer. Other symptoms can include depression, joint pain, muscle weakness and GI difficulties.

Once identified, hypercalcemia due to elevated parathyroid hormone levels is typically managed based on the severity of the calcium elevation. Very mildly elevated calcium levels in asymptomatic patients can be observed with simply monitoring or treatment with medications. When symptoms are present or when calcium levels are unacceptably high, parathyroidectomy is indicated.

In general, patients recover from parathyroid surgery very quickly, with same-day discharge. In most cases, incisions are well-hidden in existing skin creases and are difficult to notice once complete healing has taken place. All surgeons at ENT Clinic of Iowa strive to minimize incision length while maintaining the safety of the procedure. Many patients are candidates for a minimally invasive approach.

Development of minimally invasive parathyroid surgery

Since the early 1980s, minimally invasive surgery has revolutionized the surgical management of conditions in the chest and abdomen, drastically reducing recovery from invasive procedures and expanding the range of therapeutic interventions.

Some disorders of the head and neck have traditionally required large incisions to gain access to small areas or structures. Examples of this include thyroid surgery for benign nodules, parathyroid surgery, lymph node biopsy and implantation of a vagal nerve stimulator (an anti-seizure implant similar to a pacemaker).

In these cases, disfiguring incisions are made in visible areas of the neck simply for surgical access. In response to this problem, less invasive techniques have been developed and are now in practice around the globe.

Minimally invasive surgery of the neck was first developed for management of thyroid and parathyroid disorders. Since that time, a variety of minimal-access techniques have been developed which accomplish the desired surgical goal. These techniques are currently practiced worldwide, and multiple clinical trials confirming the safety and benefit of these procedures have been performed.

Dr. Wright has been performing video-assisted procedures since 2002. He performs most thyroid and parathyroid surgeries using this technology, minimizing the length of surgical scars.

Video-assisted parathyroidectomy

The video-assisted surgical technique markedly shortens incision length (typically around one inch vs. four inches with traditional surgery). It also reduces post-operative pain and speeds recovery time.

This technique has been performed thousands of times around the world with consistently safe results comparable to the conventional technique. It does not increase operative time and incurs no increased risk.

Originally developed in Italy, the video-assisted technique has only recently been taught in the United States. A handful of surgeons in this country have been doing this technique for a number of years, including Dr. Wright, who is one of the most experienced surgeons in the United States with this technique.

Side-by-side surgical comparison

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