Background: Minimally invasive parathyroidectomy (MIP) is usually performed with the concurrent use of intraoperative adjuncts for good outcome.
Objective: We wanted to show that a good success rate can be achieved in MIP without routine use of any intraoperative adjuncts.
Methods: A prospective case series of the first 100 patients who underwent MIP for primary hyperparathyroidism by a single surgeon at a single institution were included in this study. Preoperatively, patients undergo ultrasonography and/or 99 mTc-labelled sestamibi scan for localization. Methylene blue contrast is used preoperatively. Parathyroidectomy is performed via a focussed lateral approach on the side indicated by preoperative imaging. An algorithm of intraoperative decisions is followed. No intraoperative adjuncts such as gamma probe, intraoperative PTH or frozen sections are used routinely. Patients are followed up in the outpatient clinic, where serum calcium and/or parathyroid hormone levels are checked to determine success. Postoperative normocalcaemia is considered success independent of serum PTH levels.
Results: Patients had a median age of 63 years (range 2685 years). Eighty-three were female and 17 were male. Ninety-three patients underwent MIP, with 7 patients having a conversion from MIP to bilateral exploration. The mean operative time for unilateral and bilateral exploration was 42.38±12.31 and 76.43±16.51 min respectively. When used separately MIBI and USS were able to accurately lateralise side of the lesion in 82.8 and 79.5% respectively but when USS and MIBI agreed, the predictive accuracy of the side of the lesion was 87.5%. Ninety-six percent of patients had a successful return to normocalcaemia. No intraoperative or postoperative complications were encountered.
Conclusion: Excellent results are achievable with MIP even without intraoperative adjuncts. Preoperative localisation is helpful in determining side of incision. Our technique demonstrates a key principle of surgery: to keep things simple.