Endocrine Abstracts

Background: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is routinely performed in many centres. Various preoperative and intraoperative localisation techniques are used along with intraoperative PTH monitoring (IOPTH).

Results: We report the results of 110 consecutive patients presenting to our unit with a diagnosis of primary hyperparathyroidism from January 2004 until November 2007. All patients had sestamibi scintigraphy (MIBI) as the primary investigation for preoperative localisation. One hundred patients had a positive scan showing a single gland and underwent MIP by a single surgeon without any further pre or intraoperative localisation studies and without IOPTH monitoring. The remaining 10 patients underwent further localisation studies and bilateral conventional neck exploration and were not included in the study. In 95 patients, a single abnormal gland concordant with the localisation scan was identified and excised. In 5 patients, no obvious abnormal gland was identified; they were converted to bilateral neck explorations. In one among these, an abnormal gland was found on the opposite side to the scan report and was excised. In remaining 4, 3½ glands were excised. Primary outcome measure of normocalcaemia at 6 months was achieved in 95/100 (95%). Of the 5 patients who remained hypercalcaemic, a second abnormal gland was identified on repeat MIBI scan in 1 patient and successfully removed by further uncomplicated surgery. Two of the 4 remaining patients were subsequently diagnosed as suffering with familial hypocalciuric hypercalcaemia and 2 with parathyroid hyperplasia and treated conservatively.

Conclusion: In the majority of patients with primary hyperparathyroidism and a positive MIBI scan, MIP can be safely undertaken without any further pre or intraoperative localisation and without IOPTH monitoring.