What is Parathyroidectomy?
Parathyroidectomy is an operation to remove one or more of the abnormal glands that causes hyperparathyroidism. It is most frequently performed (in over 85% of patients) to remove a single abnormal parathyroid adenoma. A minority of patients may require surgery for multiple adenomas, a condition called parathyroid hyperplasia which affect all 4 glands, and in very rare cases a parathyroid cancer.
Parathyroid surgery is also performed to treat the relatively common endocrine disorder known as hyperparathyroidism, that causes elevated calcium levels in the blood and kidney stones.
How is Conventional Parathyroid Surgery Performed?
The current traditional ‘open’ thyroid and parathyroid surgery was first introduced some 100 years ago, performed through a large incision in the lower central part of the neck. This is deemed the standard 4-gland bilateral neck parathyroid exploration:
- A 5-8cm incision is made in the anterior neck near the abnormal gland and dissecting through the layers of fat and muscle to the thyroid gland.
- The thyroid gland is then moved towards the midline of the body and the upper and lower parathyroid glands are identified on each side. The surgeon removes one or more of the parathyroids, depending on the specific disorder.
- The muscles are then repaired and the skin incision is closed with sutures that will either absorb or be removed soon after your operation. Protecting the nerves controlling your vocal cords and the remaining parathyroid glands so they will function normally is an important part of your surgery.
- It is not uncommon to have a low calcium level after a successful surgery. That situation is nearly always temporary and normal function is restored in over 96% of people in just a few weeks.
- This operation has a success rate of 90-95% in terms of long term cure when performed by an experienced parathyroid surgeon.
What is different about Minimally-invasive ‘Key-hole’ Parathyroidectomy?
With advances in surgical technique and instrumentation, such as the nerve monitor, ‘harmonic scalpel’ and endoscopic equipment, we are often capable of removing thyroid or parathyroid lesions through an incision on the neck that is less than an inch long leaving a scar is therefore much less visible. Many international expert and world-wide centres of excellence have adopted minimally-invasive parathyroid surgery (MIP) as their preferred surgical approach. Research studies have consistently shown that both the conventional ‘open’ & Minimally invasive ‘key-hole’ techniques all offer a similarly high success rate (98%). The main differences are:
- Minimally invasive, or ‘keyhole’ surgery requires identification of the abnormal parathyroid gland before operation, usually with an ultrasound scan and/or a sestamibi (SPECT-CT) scan.
- The majority of these surgeries being performed through an incision less than one inch. Using high-definition endoscopes and video equipment, the pre-localised offending parathyroid adenoma is targeted using minimal dissection to cause minimal tissue trauma.
- The latter is the reason for the reduced pain and neck swelling and the faster recovery seen in these patients. Once the parathyroid adenoma is found and carefully excised, we use the advanced ‘ rapid Intraoperative PTH assay’ to measure the parathyroid hormone level in the blood directly in the operating room.
- This should return to normal within 15 minutes of removing the abnormal parathyroid gland. This result is therefore known before the operation is concluded to ensure cure has been achieved.
- Simple sutures are all that is required as the incision and operative wound is so small. As a result, often skin glue can be used to close the skin incision.
A SPECIALIST PRACTICE FOR THYROID & PARATHYROID SURGERY