Endocrine Abstracts

Introduction

Parathyroid surgery is indicated essentially in primary and secondary hyperparathyroidism. This surgery may present some difficulties even in experienced hands. Our aim is to describe the difficulties that can occur during parathyroid surgery.

Material and methods

A retrospective study including 81 cases of hyperparathyroidism, operated between 2001 and 2018.

Results

The mean age was 53.2 years. Our study included 67 cases of secondary hyperparathyroidism and 14 cases of primary hyperparathyroidism. All patients, having secondary hyperparathyroidism, underwent subtotal 7/8 parathyroidectomy. In the majority of cases (80.6%), the parathyroid glands were found in their usual locations, without intraoperative challenges. Intrathymic localization was noted in 5 cases (thymectomy was done in these 5 cases). Two parathyroid glands were superposed in 5 cases. Parathyroid glands were located in the recurrent laryngeal nerve’s entry point into the larynx, in 3 cases. In cases of primary hyperparathyroidism, intraoperative difficulties were noted in 4 cases: prevertebral parathyroid gland (1 case), latero-tracheal parathyroid gland (2 cases) and parathyroid gland located between the trachea and the oesophagus (1 case).

Conclusion

Preoperative imaging has an important role in the guidance of the surgical procedure. Nevertheless, a good knowledge of the surgical anatomy of the parathyroid and thyroid glands is essential to overcome the difficulties that can occur during parathyroid surgery.