The
graph on the left is very important for patients with parathyroid disease
to know and understand. There is a big difference in cure rates following
parathyroid surgery depending upon which operation is performed, and the
amount of parathyroid experience the surgeon has. Minimally Invasive
Radioguided Parathyroid surgery (MIRP) has been reported in many medical
journals since 1997 to have the highest cure rate of all parathyroid
operations. Some patients (about 10 percent) still have to have the
"standard parathyroid operation" (see the page on Who
is Eligible). For these people, having the operation performed by an endocrine
surgeon improves the cure rate significantly.
Reasons Why Surgeon Experience is so Important in
Parathyroid Surgery
 | The average number of parathyroid operations that surgeons
perform in the U.S. during their residency (surgical training)
is 1.5 (less than 2 parathyroid operations). |
| The number of parathyroid operations the average general
surgeon in practice in the U.S. performs annually is less than
2. It is NOT a very common disease. |
| Parathyroid anatomy is the most variable anatomy
in the human body. |
| The normal parathyroid is the size of a grain of
rice...smaller than a pea, and
can be found anywhere in the neck from the jaw down into the
chest next to the heart. |
| Parathyroid disease can be caused by one bad parathyroid
gland, or it can be caused by 2, 3, or 4 bad parathyroid glands. |
|
There
are really only two potential complications possible during parathyroid surgery,
both of which are uncommon. However, the type of surgery and the
experience of the surgeon dramatically effect the potential rate of both complications.
This graph shows the risk of injury to the nerve that controls the vocal
cords. Injury to this nerve during a parathyroid operation can make the
patient's voice horse. The MIRP operation only operates on one side of the
neck and it is a much smaller operation, so the risk is the lowest for
this operation (less than 1 percent, shown in blue). The old-fashioned
standard parathyroid operation has a nerve injury risk of about 1 percent
when performed by experienced parathyroid surgeons (shown in red). When
performed by surgeons who do parathyroid surgery infrequently, the risk
can be doubled (shown in green). NOTE...this may seem like a low
rate, but this is a terrible complication of parathyroid
surgery, leaving the patient with a hoarse voice (sometimes forever), and
often the patient can't speak except for a whisper. (Note,
Dr. Norman has never had one of these complications). Don't take
this lightly! Make sure you discuss this with your surgeon!
The
second risk from parathyroid surgery is the removal of all four
parathyroid glands (un-intentionally), leaving the patient with NO
parathyroid glands. This is called hypOparathyroidism (too little
parathyroid hormone) and it can cause some bad symptoms (read
more). This complication is also quite rare, but differs according to
surgery type and surgeon experience. The MIRP mini parathyroid surgery has
a ZERO theoretical risk of removing all four parathyroid glands since only
one side of the neck is explored (shown in blue). As shown in green,
surgeons who do not perform parathyroid surgery very often have a risk of
causing hypOparathyroidism nearly double that of experienced endocrine
surgeons (shown in red) who have about a 1 percent chance of this
complication.
About
one out of every ten patients operated on by an expert parathyroid surgeon
is a patient that has already been operated on by a general surgeon (or an
ENT surgeon) who did not find the bad parathyroid gland. Several clinical
studies have shown that radioguided parathyroid surgery is extremely
useful in these cases. Once again, the graph on the left shows how the
MIRP mini-parathyroid operation has about a one percent chance of not
finding the bad parathyroid gland. The standard operation is not near as
good, when performed by an endocrine surgeon (shown in red) or by a
general surgeon (shown in green).
Finally,
this graph combines all of the other data into one graph to show the
chance of having a 'great' outcome (cured of the disease without any
complications from the surgery). You can easily see that an experienced
endocrine surgeon performing a MIRP mini-operation (shown in blue) has by
far the highest chance of a 'great' outcome. A standard parathyroid
operation on both sides of the neck performed by an experienced endocrine
surgeon (shown in red) should have a 'great' outcome about 94% of the
time, while a standard parathyroid operation performed by a general
surgeon (or ENT surgeon) has the lowest chance of a 'great' outcome.
A surgeon
who has performed less than 250 thyroid and parathyroid operations
is 'inexperienced'.
Did you know that there are only 147 practicing
endocrine surgeons in the U.S.?
HELPFUL
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