This page of Parathyroid.com
is the narrative
to the video of the 13 minute 4-gland MIRP mini-parathyroid surgery performed
by Dr Norman on a typical patient with hyperparathyroidism. This
parathyroid operation is very quick, so this page will help you understand all that is going
on and shows why all four parathyroid glands must be evaluated by
your surgeon. Most
questions patients with hyperparathyroidism have about parathyroid
surgery and sestamibi parathyroid scans are covered in this video.
There just isn't
time to discuss all that is occurring in the video itself, so this page was
made to help you understand what is happening. Updated
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Read this page while you watch the video (the entire 4-gland
MIRP mini-parathyroid operation takes less than 13 minutes). Many people watch the video several times coming
back to this page several times so they understand all that is occurring
during this very quick operation. This is one of the most educational
pages of Parathyroid.com--this video explains the most common
questions people with parathyroid tumors have, even illustrating how
scans are usually wrong even when positive. Sit back, watch, and
learn why all four parathyroid glands must be evaluated.
NOTE: There is absolutely no blood on this parathyroid surgery video. Most of the
video shows the doctors talking about what is happening and you don't see
much of the actual operation like you do in our other,
more formal video. We want all our patients to watch this video
because it is so educational.
The movie is narrated by Dr Doug Politz as Dr Jim Norman performs the
operation. At the time of this filming (August 02, 2011) Dr Norman had
performed over 20,000 parathyroid operations. As a team, Drs Norman,
Politz, Lopez, Boone, and Mitchell perform about 65 parathyroid operations per
week (about 3,100 per year),
virtually all of them are performed like this one. This operation is a 59
year old man that weighs 190 pounds. The main learning points are
presented in groups.
Anesthesia for the Parathyroid Operation
We do not use an endotracheal tube on our patients.
That means we don't put a tube down into the trachea for deep general
anesthesia. This patient is asleep enough so he doesn't feel anything or move,
but he is awake enough so that he breathes on his own and not by
machine. The drugs used are similar to the drugs used for
colonoscopy--they are given into the vein. We don't need big-time,
aggressive anesthesia and "nerve monitoring" for such a
quick operation. If your surgeon wants to put a tube down your trachea
so he/she can "monitor" your vocal cord nerves, you must
understand that this means you are having a bigger operation than you
need (and your chance of vocal cord injury is more than double). The CalciumPro
app has a complete section on "How to Find a Parathyroid
Surgeon". Another reason to download the CalciumPro
parathyroid diagnosis and risk-assessment app.
Incision to Allow Examination of all Four Parathyroid
We put the incision in the same place on all patients.
The incision must be put in the middle so we can get to all the
parathyroid glands on BOTH sides of the neck. Any surgeon who puts an
incision off to one side or the other should have his/her hands
smacked with a ruler--it is never done by an expert. Any
operation that has the incision placed off to one side has a cure rate
of 85% at best (you will understand that after you see the video).
With a number of surgical "tricks" learned
from doing many thousands of these operations (that you can't appreciate completely because you can't see into the wound),
can see all four parathyroid glands through this incision that is just
under 1 inch in this man. We do not need a big incision to see all
four glands. Also, we evaluate the entire thyroid through this small
incision. Most of our operations are done through incisions that are 1 inch.
This Sestamibi Scan is Great Quality and Clearly
Positive: But Wrong!
It is VERY important to realize that this man had TWO parathyroid tumors
even when the scan said he only had one. Of course we did not know
this ahead of time--there is no way of knowing which patients will be
one of the 25-30% that have two. When we found two in this man, it gave us the
perfect opportunity to show that sestamibi scans are over-emphasized
and are usually wrong. This case was not staged, but several important
points about sestamibi scans are made during this video such that you
may think we knew that this man had two tumors ahead of time--but we did not! We look at all four parathyroid glands in almost every parathyroid
operation we do--because you can't tell by scan how many bad ones exist. This is why we roll our eyes when our
patients have a scan and then ask us "how many bad parathyroid
glands do I have?" We tell them: "We don't know, we haven't performed the operation yet". Listen up folks... scans
can never tell you how many glands are bad. If you learn nothing else
from this parathyroid operation video, then learn that scans are not
accurate, and are just a tool we use. The scan will not hold the
answer to your problems. Scans cause more problems than they solve.
Scans are wrong more than they are right! Chill on the scan folks!
And tell your doctors to chill on the scans too!
This sestamibi scan clearly shows a normal thyroid and
one large parathyroid tumor. This scan is as good as it gets, and it
is absolutely perfectly positive showing ONE parathyroid tumor. Note
that the scan is better and brighter in real life, and on the
video--it doesn't reproduce well here. About 18 years ago when Dr Norman was first developing mini-parathyroid
surgery he was of the opinion that a very good quality sestamibi scan
(like this) showing a single parathyroid tumor would allow for a one-side
(unilateral) parathyroid operation. If there was ANY question about a second tumor,
then both sides of the neck would be examined, but in cases like this,
he would have (many thousands of operations ago) operated on only one
side of this man's neck. This case is the absolute perfect example
that shows a one-side parathyroid operation will have a cure rate of
only 90-93% by even our surgeons (who do 50 a week) because some of these folks will have a second tumor that
CANNOT BE DETECTED EVEN THE BEST SCAN IN THE WORLD. Lesser experienced
surgeons using scans that are not as good get cure rates of 85-90%
with one-side operations. At virtually
every other hospital in the world, this man would have had a one-side
(unilateral) parathyroid operation the way Dr Norman developed mini-parathyroid
surgery 10-15 years ago and this man would have been "better"
but not cured. He would have been "better" because a large
parathyroid tumor was removed, but he would not have been cured and he
would need a second operation anywhere from 3 months to 2 years later
to remove the second tumor (that was smaller, and not detected on the
scan). We rarely do a one-side parathyroid operation any more, for the reason you
see on this video--a second parathyroid tumor can be hiding and the
scans will miss it! Besides, as you saw on the video, we can look at
all four parathyroid glands so fast it doesn't make much sense not to
do so. The only way to get near 100% cure is to examine all four
glands and see how active each one is. Period. One more note folks,
"mini" does NOT mean "one-side". Our operations
are smaller than anybody else's in the world, and ours are both-sides.
About 18% of the operations we perform are on people
who have had one (or more) parathyroid operations somewhere else that
did not cure them (we do 2-4 re-operations daily). Often it is because
they had a one side operation that removed a tumor and their labs did
not become completely correct afterwards. These folks have a second
parathyroid tumor just like this man. Even though the sestamibi scan
clearly shows only one parathyroid tumor, up to 15% of people will have
a second tumor that does not show up. Only the big tumor shows up on
the scan, the smaller tumor is being suppressed by the big one so it
doesn't show up. If you don't remove the second tumor it will continue
to grow (all tumors do) and become the dominant tumor and these patients are not cured of their
hyperparathyroidism. These patients will need a second operation to
take out the second tumor. We do NOT perform one-side parathyroid
operations routinely--about 99% of the operations we perform are
exactly like this--examine all four parathyroid glands quickly and
safely. We invented the one-side operation--yet we won't do it any
more because even with our experience it simply won't cure some of the
patients. If your speak to a surgeon and he/she is going to operate on
one side of the neck and then measure your hormone levels to see if
you are cured, then write down our phone number--because 15% of you
will come here for your second operation.
The lesson learned here is that sestamibi scans are
usually wrong. If they are negative then they are wrong 100% of the
time--the patient has a tumor and it is just hiding behind the thyroid
and it can't be found. If the sestamibi scan is positive (like it is
in this video), then it is wrong about 60% of the time (like it is in
this video). Hey! Are you listening? A negative scan is wrong
100% of the time. A positive scan is wrong about 50% of the time! Stop
worrying about the scan! Stop getting scans!
After you see this video you will understand why we
say emphatically that all our patients get a mini-operation. We
perform the same mini-operation on patients with a negative scan as we
perform on patients with positive scans. This patient is the perfect
example, the RIGHT side of his neck had a positive scan and one
parathyroid tumor and one small normal gland. The LEFT side of his
neck had an excellent quality, perfectly negative scan. The
operation we performed on the left side of his neck was exactly like
the operation performed on the right side. The scan-negative left side
of his neck had a parathyroid tumor and a normal gland--just like the
scan-positive right side. We perform the same mini-parathyroid
operation on all people, and those with a negative scan have the same
mini-operation that takes the same amount of time as those people with
a positive scan. As you can see on the video, the operation on the
left side (the negative side) was actually faster than it was on the
If you think that you are getting a Mini-Parathyroid
Operation because your surgeon has seen a positive scan and they will
then operate on one side of your neck, then understand that you may
need a second operation, as shown in the graph below. If your endocrinologist says "we will
get a scan to see if you can have a mini-parathyroid operation",
then know your endocrinologist has never seen a parathyroid operation
in his/her life because that is not true. Send this video to them. The
mini parathyroid operation is dependent on the skill of the surgeons,
not the accuracy of the scan. Patients with negative scans and
positive scans should have the exact same operation.
We know that the vast majority of people watching this video
will be operated on by somebody else because they cannot afford to
come to Tampa. However, when you see your "local" expert,
ask them about this video and see what they say. Listen to their
excuse as to why they won't look at all four glands. Every day we
operate on people who had one parathyroid gland removed somewhere else
and that surgeon did not look at all four glands. Here is why: .
graph shows the recurrence rates (how often somebody gets parathyroid
disease a second time requiring a second operation). The blue line
shows that people almost never get parathyroid disease a second time,
if your surgeon operates on both sides of your neck and looks at all
four parathyroid glands. Said differently, if your surgeon tests all
four parathyroid glands, you can be assured you will be cured forever
almost 100% of the time. HOWEVER, if your surgeon operates only
on one side of your neck and tells you that he/she has cured you
because they successfully removed a parathyroid tumor, then you have a
10-12% chance that you will NOT be cured during this operation. AND,
even if you are cured, you have another 10% chance that you will need a
second operation in the next 10-15 years
because you are like the man in this video who had two tumors and the
surgeon only removed the biggest one.
Importantly, this means you will never have any of the benefits of the
first surgery--you will not feel better, your heart disease will not
get better, your osteoporosis will continue to worsen, and your risk
of developing several types of cancer will remain high. Dr Norman is
the inventor of one-side parathyroid surgery, yet he no longer
performs this operation. Fortunately, as you can see from this video,
a skilled surgeon can test all four parathyroid glands in less than 20
minutes on almost every patient--even if the scan is negative. Note:
this graph comes from an upcoming publication by Drs Norman, Politz,
and Lopez: DRAMATIC
DIFFERENCES IN LONG-TERM CURE RATES FOLLOWING UNILATERAL VS. BILATERAL
18-YEAR, SINGLE-CENTER STUDY IN 16,500 PATIENTS. .
We tell people all the time: Do not get a sestamibi
scan if you want to come to our center--we will not look at it. Scans
are wrong more than they are right. If your doctor puts all sorts of
emphasis on the scan, you will know that this doctor is not an expert.
After you watch this video, you will know that scans are usually wrong
and what you want is a skilled surgeon, not a good scan. Forget the
scan, it's not about the scan. It's not about the golf clubs, its
about the guy swinging the golf clubs. Stop emphasizing the scan--or
better yet, refuse to get one. It isn't necessary and will be wrong.
"Geeze Dr Norman, if the scan is so worthless,
why do you get one just before your patients go to the operating
room?" Because we use the scan to give us different
information! We do NOT use the scan to find the tumor (like your
doctor will do). We use the scan to make sure your parathyroid is
not in your chest. We use the scan to see if you have a thyroid
goiter, or there is a thyroid problem (like a cold nodule) that needs
to be addressed while we are in there taking out the parathyroid
tumor. We use the scan to make sure your parathyroid tumor isn't in
some weird place like under your jaw or next to your heart. We use the
scan to make sure there are no "surprises". Therefore, the
NEGATIVE information that the scan gives is much more important than
showing the parathyroid tumor. Clearly this video shows we have the
expertise to find parathyroid glands very quickly and safely. We just
don't like surprises! Most of all, however, we use the scan because we
need the parathyroid glands to be radioactive so we can use the probe
to determine how much hormone each of the parathyroid glands are
making (read below). Most doctors get scans so they can
"find" the tumor. The scan is not very good at this--even
when it is "positive", it will be wrong 60% of
the time. Stop getting scans!
Blood Loss During the Parathyroid Operation
During the operation Dr Norman shows a small sponge
with a few drops of blood on it. There is no trickery here...
parathyroid surgery can and should be virtually bloodless.
All Four Parathyroid Glands are Examined
We look at all four parathyroid glands in about 99% of
parathyroid operations we do. There are some rare exceptions not worth
discussing here. If you come to our center for a parathyroid
operation, you can expect to have all four of your parathyroid glands
examined to see 1) how big they are, and 2) how much hormone they are
making. It is simple: the good ones stay in, the bad ones come out. Of
our last 10,000 patients, we removed more than 1 parathyroid gland in
about 25% of people. That puts them on the blue line in the
graph above and keeps them off the red line!
All four parathyroid glands can be examined for their anatomy and
hormone production through a very small incision. This incision is
smaller than anybody else in the world makes. We make this same little
incision all day long, every day.
All four parathyroid glands can be examined in less than 10
minutes from the time the operation starts. (Believe it or not, nobody else in
the world can do a 4-gland parathyroid operation in less than 1 hour).
One of the reasons we made
this video is because many surgeons say it is impossible to do a
4-gland parathyroid operation in less than 1.5 hours. Unless they see
it with their own eyes, they don't
believe that we can do this in less than 20 minutes. This is why we
shot the entire video with one continuous filming. There is no
editing, and we show the clock many times. No trickery here: a surgeon
that does the same operation many times per day for many years gets
very, very efficient.
You can see the pathology report from this operation here: images/VideoPathReport.pdf.
It shows that two parathyroid adenomas were removed and two normal
glands were identified and biopsied. No trickery here.
The Probe Measures Parathyroid Hormone Production from
This is "MIRP" Minimally Invasive Radioguided Parathyroidectomy.
The probe is used to measure parathyroid hormone (PTH) being
produced from each parathyroid gland. The probe measures the
"activity" of any parathyroid gland. This is a 4th generation probe,
a probe (and technique) that was invented (and patented) by Dr Norman
in the mid 1990's.
MIRP is an acronym made up by Dr Norman in 1994 which means
"Minimally Invasive Radioguided
Parathyroidectomy". It means the probe is used to
measure hormone production from the parathyroid glands using
radioactivity, allowing the surgeon to get almost immediate feedback
on the status of the parathyroid glands instead of measuring hormones
from the blood (which takes an hour and is not as accurate) or getting
frozen sections where the gland is removed and sent to the pathologist
who looks at it under the microscope (which is completely stupid and 1945 technology). MIRP
surgery has the highest cure rates because the probe assures that
normal glands are left in, and all of the abnormal glands are removed.
Sounds simple... but if your doctor is not using a probe, this is not
The probe measures radioactivity. The radioactivity attaches
inside the parathyroid cells where PTH is being produced. Thus, the radioactivity contained
within each parathyroid gland is equal to the amount of parathyroid
hormone that the gland is producing. Parathyroid tumors that are
producing lots of hormone become very radioactive. Normal parathyroid
glands become dormant (go to sleep) when the calcium is above 10.0
mg/dl, thus normal glands have almost no radioactivity in them. The
probe is used to determine which glands are bad (making hormone) and
thus need removed, and which parathyroid glands are good (they are
dormant and not making hormone) and thus should NOT be removed. During
the operation on the video, Rob (one of the assistants) takes the
parathyroid samples from Dr Norman and scans them with the probe. The
probe is connected to a computer which converts radioactivity into the
amount of PTH produced.
The probe is connected to a computer which calculates the amount
of hormone being produced from each gland based upon its contained
radioactivity. The operating room staff perform these tasks while the
surgeon continues to operate. The amount of hormone each gland is
making is recorded and becomes a part of the patient's medical
records. This also helps us understand how much calcium each patient
will need in the few weeks after the operation. A lot can be learned
by knowing what the other parathyroid glands are doing--another reason
why we want to see and evaluate all four glands in all patients.
During the video you can see that the probe takes a measurement
of the two tumors, and small pieces of the normal glands. We've
measured the amount of radioactivity contained within well over 55,000
parathyroid glands. From these measures we have developed a
standard-curve that converts the number seen on the probe into units
of parathyroid hormone being produced. The numbers you see on the
probe are not the amount of hormone, a computer makes this
calculation. You can see the relative values... normal glands contain
between 25 and 60 counts of radioactivity, while tumors are over 250
counts. The large parathyroid tumor in this man had about 2200 counts of
radioactivity and the second tumor had 539. The computer converted
this to 2873 pg/ml hormone production from the first tumor, and
719 pg/ml hormone production from the second tumor (see photo
below). The normal
parathyroid glands converted to 19 and 21 pg/ml/min, which shows them
to be dormant (making almost zero hormone).
It takes the probe about 2 seconds to measure the amount of
hormone being produced from a parathyroid gland. We do not use
intra-operative PTH monitoring, which is where the parathyroid hormone
in the BLOOD is
measured during an operation. That technology takes 45 minutes to know
the answer and you have to wait 10-20 minutes after the parathyroid
tumor is removed before you can draw the blood. Thus, it takes about 1
hour to perform intraoperative PTH monitoring (every time it is used,
and usually surgeons use it multiple times per operation--which is why
so many surgeons take 4-6 hours to do a parathyroid operation. We try
hard not to poo-poo this technology, because it can help surgeons who
don't do this operation very often. But we can tell you this, no
expert would rely on intraoperative PTH monitoring. It is a tool for
inexperienced surgeons. This is the only place on this 500-page
website that we mention this technology. We would never use it because
it is wrong 18% of the time and takes 1 hour. We operate on 1-2 people
every day who had a one-side operation with the incision placed over
to the side because they had a positive scan and their surgeon removed
only one tumor and then measured intraoperative PTH levels--which
showed a 50% drop in hormone. This is a fine test for non-expert
surgeons and it can help them do this operation with an 85-90% cure
rate. But, that means we get to remove their patient's second
tumor--just like you saw in this video.
We Take a Photo of the Parathyroid Tumors We Remove
We photograph all parathyroid tumors we remove. These photos
become a part of your medical record with us and we send a copy of the
photo to all your doctors (to teach them!). You will also get a copy
of the photo. This is the actual photo from this operation that you
saw nurse Laura take and then Dr Norman hold in front of the
camera at the end of the video.
The photo will have on it the amount of hormone that the remove
tumor(s) was producing. In this case, the smaller tumor was making 719
pg/ml/min PTH hormone and the larger making 2873 pg/ml/min.
The amount of hormone each of the other (normal) glands was
producing also becomes a part of your record with us. This means
there is no question about the function of the other glands.
There should be no question that the normal glands are NOT
removed. Trust us folks, surgeons who don't use this technique
remove NORMAL glands all the time because they have no way of
knowing if any particular gland is overactive or dormant.
The white sticker at the top left of the photo shows the level of PTH in this man's blood 1
hour after the operation (we draw the blood in the recovery room
as the patient is about to walk out of the hospital). Prior to
the operation his blood PTH was 122 pg/ml. Now it is 14.7 pg/ml.
The normal range is between 15 and 60 pg/ml. Thus, his PTH is
below normal because the only parathyroid glands he has left are
dormant (asleep) and doing very little. They always wake up in a
few days. We know 100% he is cured because: 1) we saw and
evaluated all four glands, 2) we removed two tumors, 3) the two
glands that are left were proven during the operation to be
asleep, and 4) 45 minutes after the operation his PTH has
decreased to below normal. Note that had we taken
out only the big tumor (the only one that showed on his scan),
his PTH in the recovery room would be in the normal range
(roughly 30 to 40). This would be lower than the starting point
but not low enough. Within a week or two, the second tumor would
be making far too much hormone and this man would still have
calcium levels above 10.3 mg/dl, meaning that he would need a
No Frozen Section Analysis to "see
if it is a parathyroid gland"
If you aren't a surgeon, or don't work in an operating room then
a very important aspect of this operation is not being appreciated.
Normally (in every other parathyroid operation in the world) the
removed tumor and the samples (biopsies) of the normal glands are put
into small containers and sent to the pathology department of the
hospital so a pathologist can look at the tissue under a microscope. We
do not do this. This is called "frozen
section" analysis of the tissue. During the frozen section,
the pathologist looks under the microscope and then calls the surgeon
on the phone (while he/she is still operating) and reports 1) if this
is a parathyroid gland or some other tissue (like a lymph node), and
2) if the parathyroid gland is full of lots of parathyroid cells or
lots of fat. The concept here is that parathyroid glands full of fat
are normal (dormant), and those that are full of lots of cells and
little fat are bad parathyroid glands. Unfortunately, this is
technology out of 1935 (not kidding), and the normal range for the
percent fat is between 30 and 90%. This is absolutely the most
ass-backwards thing that surgeons still do. If you want a chuckle, ask
your surgeon if he/she is going to "get frozen sections".
They will of course say "yes". Then you ask them why and
watch them squirm. Ask them "can't you tell its a parathyroid
gland and not a lymph node by looking at it?" If they say
"not always" then know they are not experts. Do you
sometimes not recognize your own kids? Surgeons perform frozen
sections to make sure they found a parathyroid gland and not a piece
of fat or lymph node. This is just as the old guys did it
back in 1955, the old guys who taught these guys. We stand amazed
every day that our peers continue to perform surgery like it was 1955.
Frozen section analysis costs $285 for the first one, and $195 for
the subsequent ones (this is what Medicare pays the pathologists).
We've seen surgeons get 20, 30, and even 40 of these dumb tests. While
we are talking about cost, know that the intraoperative PTH assay
discussed briefly above cost about $400, and when surgeons use this
method they get a minimum of three, and often about 6. Now you know
why our center is a "preferred provider" for parathyroid
surgery for Medicare, Blue Cross/Blue Shield, Aetna, Cigna, Humana, etc, etc.
We are cheaper for the insurance companies and have the highest cure
Frozen sections take about 12-15 minutes each (minimum!) once the
tissue leaves the operating room. It takes the operating staff at
least 2-3 minutes to fill out the paperwork for each specimen before
it can even leave the operating room. Thus, if
your surgeon is going to look at all four parathyroid glands, he will
absolutely get a frozen section on each one. Now you can see one more
reason why most parathyroid operations take 2-5 hours.
Absorbable Stitches to Close the Wound
All the stitches we use to close the wound absorb in about 1.5
months. They don't exist anymore after that. Note that the stitches
used to close the skin are too small to see on the camera (smaller
than a human hair). Thus there are no stitches to remove. Look folks,
there are still a lot of surgeons out there using staples and ugly nylon
stitches to close these wounds. This means that you have to go back to
the doctor a week later to get the stitches removed, and it means you
get an ugly "rail-road" scar. Ask your surgeon what kind of
stitches they use on the skin--if they say you have to come back to
the office to get the stitches removed, then get up and run.
RUN! It is not 1965 anymore.
Bandage: The band-aid we use is a simple steri-strip. You can
shower the very next morning and get it wet. Just peel it off in one
week. That's it.
Watch the Actions of the Operating Room Staff
The techs and nurses that operate with our surgeons have
been with us for years. These team members have performed
many thousands of operations with these surgeons. Note that they give
the instruments to Dr Norman during the operation without Dr Norman
having to ask. They measure the size, weight, and hormone production
from the parathyroid tumors that are removed (and the small biopsies
of the normal glands which are not removed). Everybody in the
operating room does this operation exclusively; they work in our
parathyroid center and they don't assist on any other type of operations. Our
excellent staff is another reason why we are so efficient. Everybody
knows what they are doing and has done it thousands of times before.
Also note that there are no surgery residents (surgeons in training)
working with us.
Home in 1 Hour
This man went home just over one hour after the operation. Most folks
stick around about 1.5 hours. Some wake up faster and go home about 45
minutes after the operation while
some feel a little punk and stick around 2 hours or so. Less than 1 in
1000 people spends the night with us. If your surgeon says that you may have to spend the night in the hospital, then you can bet
your surgeon doesn't perform many of these operations per year.
All of Our Surgeons are Really Good!
The video shows Dr Norman operating. Dr Politz, Dr Lopez,
Dr Boone, and Dr Mitchell do this same exact operation with the same exact level of
expertise--they have been trained by and operate side by side with Dr
Norman for thousands of cases before they are allowed to operate by
themselves. Don't think you must have Dr Norman perform your operation. He'd let
his partners perform his parathyroid operation, so you should too! All
five are by far the most experienced parathyroid surgeons in the world (and they work in groups of
two or three, so almost all of our patients get two of the 4 most experienced
parathyroid surgeons in the world).
Mini-Parathyroid Surgery Summary
This 13-minute operation seems pretty darn simple, yet no other
surgeons in the world can do this operation this quickly, or with this
high of a cure rate. Remember, this is what we do
all day, every day. We don't do anything else. This was a routine parathyroid operation at our
center; we just had a medical student come into the operating room and
start filming. It wasn't staged. It was one of 12 parathyroid operations
we performed that day. We wanted it to look like a casual YouTube video
that wasn't a big production. If you liked the video on this page, then go
to our Teaching
Videos Page to see lots of other award-winning videos.
simple as this operation seems, know that this is the operation that most surgeons require 2-5 hours to
complete via a scar that is 5 times larger. The photo on the right is
from a woman who had "mini" parathyroid surgery in Dallas, Texas
in 2010. It took almost 4 hours and she spent 2 days in the hospital.
During the operation 12 frozen sections were performed and 2 normal
parathyroid glands were removed. Even other experts take 1.5 to 4 hours to do this exact operation.
folks, this isn't a race, and when the situation dictates, these
operations slow way down--heck we even have special magnification scopes
and special instruments that we use if the tumor is adjacent to the voice
box nerve. About 27% of the time we take time to remove parts of the
thyroid in patients who have worrisome thyroid nodules (removing thyroid
nodules takes about 2-4 minutes). Heck, we even find
surprises on people's thyroids once a week or so that dictates we take
large portions or even all of the thyroid out. Every patient is treated
like they are our only patient. Every patient has his/her own special
situations. However, this operation is very typical. About 92% of our
operations take less than 20 minutes. Scan-negative patients have the
exact same, quick operation. We do not perform mini-surgery only on
people with a positive scan--we do it on all patients. (did you follow
As you can see in
our video, surgeons and their operating room teams
become very efficient and very fast when they are highly specialized. Some
credit is due Dr Norman as he is a gifted surgeon.
He has performed more neck operations than any other doctor, and has
seen/touched more thyroid glands and parathyroid glands than any other
doctor--ever. Of course, his partners Doug and Jose are right behind
him--you don't need Dr Norman to have this operation--Drs Politz and Lopez
do this exact same operation--we work as a team and if you come here you
get two of them.
If your doctor says that mini-parathyroid operations can only be done if
the scan is positive, show this video to them--it is all dependent on the
skill and experience of your surgeon and is NOT dependent on the results
of the scan. If your doctor says that it is impossible to look at all four
parathyroid glands in less than 1.5 hours, show this video to them. In
2013 our average operation
takes just under 17 minutes. At least 4 operations per day are 15 minutes
or less. The most common duration for a 4-gland
exploration is 16 minutes. We do 11-13 of these operations daily, 5
days per week. We have a great team and everybody on the team takes pride
in what we do. We strive to take better care of our patients than they can
get anywhere else. There is a reason why over 2600 people travel to Tampa
every year for their parathyroid operation--because this is all we do.
Message from Dr Norman: We hope you learned from this video. We know we can't
operate on everybody with a parathyroid tumor. We do know, however, that
this website and these videos are changing the way parathyroid surgery is
performed. We are forcing other doctors to adopt new technologies, or to
decline performing these operations, sending the patients to another
surgeon with more experience. Let's get everybody the best care they can
If you like learning by watching videos, then check
our our Video Page!
Contact us to have our team of experts take care of
hour visit with us and your parathyroid disease is over. See our page
on "How to be Our Patient"
is an educational service of the Norman Parathyroid Center,
the world's leading
parathyroid treatment center
performing over 3,100
parathyroid operations annually (average 64 per week). We are part of the national
Calcium is BAD" campaign.
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