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Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review

Published online by Cambridge University Press:  28 October 2011

D Gracie  and
S S M Hussain
D Gracie*
Affiliation:
University of Dundee Medical School, Ninewells Hospital, Dundee, Scotland, UK
S S M Hussain*
Affiliation:
University of Dundee Medical School, Ninewells Hospital, Dundee, Scotland, UK Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
*
Address for correspondence: Mr S S Musheer Hussain, Consultant Otolaryngologist, Honorary Reader, Ward 26, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Fax: +44 (0)1382 632 816 E-mail: musheer.hussain@nhs.net
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Abstract

The past two decades have seen rapidly changing attitudes towards the surgical management of primary hyperparathyroidism. Advances in localisation techniques and confidence with endoscopy have led to the development of numerous minimally invasive parathyroidectomy approaches, including open minimal incision and endoscopic and video-assisted parathyroidectomy.

This paper systematically reviews the evidence for these methods to determine: (1) whether these new, minimally invasive techniques are comparable to conventional bilateral neck exploration methods in terms of success and complication rate; and (2) if they are comparable, which technique is likely to be best for cosmesis, patient safety and patient satisfaction.

A search of the Medline, Cochrane Reviews and Scopus databases was conducted, using a defined list of search parameters. Abstracts were compared against inclusion and exclusion criteria, before the full text was sought and analysed for data. The evidence from each study was then assessed, based on study quality, and a recommendation made based on the level of evidence available.

There is level 1b evidence that minimally invasive surgery is comparable to bilateral neck exploration in terms of efficacy and complication rates. This paper recommends that the treatment of choice for solitary adenoma (in most healthcare centres) should be open minimal incision parathyroidectomy, due to advantages in operative duration, learning curve and cost-effectiveness.

Keywords

Primary HyperparathyroidismParathyroidectomy, Video-AssistedSurgical Procedures, Minimally InvasiveSystematic Review
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 3 , March 2012 , pp. 221 - 227
Copyright
Copyright © JLO (1984) Limited 2011

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