It is clear that
ALMOST EVERY patient with primary hyperparathyroidism is a
candidate for
minimally invasive
parathyroid surgery using intraoperative nuclear mapping (MIRP).
This is also called "radioguided parathyroid surgery". About
99% of all parathyroid patients can have this mini operation. Even
if a person has a NEGATIVE sestamibi scan, they can still have a mini
parathyroid operation that uses these new techniques! Thus,
virtually ALL patients can have a smaller, simpler, faster, and more
successful parathyroid operation using radioguided techniques. This is
very important for you to know!
While
virtually every patient can have a smaller, radioguided parathyroid
operation, those with a single radioactive
parathyroid gland on high-quality sestamibi scan can have the smallest
version of this mini-parathyroid operation (typically lasting around 14 to
20 minutes).
Remember, about 5 percent of all patients with primary
hyperparathyroidism will have four-gland hyperplasia--which
means that all four of the parathyroid glands have become diseased and are
over-producing parathyroid hormone. About 1 in 100 or so will have the rare multiple
parathyroid adenoma which is 2 bad glands and 2 normal glands. But
regardless of what problem exists with the parathyroids (1 bad, 2 bad, 3
bad or 4 bad) ALMOST ALL patients can have a mini parathyroid operation IF
THE SURGEON KNOWS HOW TO DO IT.
Of the 95 percent of patients that have a single bad parathyroid
gland (a parathyroid adenoma), most will have a sestamibi scan that shows
the bad gland (very dependant on how good the scan is an how often the
radiology tech does the scan--read more about
sestamibi here). Some people with just one bad parathyroid will not have a sestamibi scan which shows
which parathyroid gland is the bad parathyroid... HOWEVER, they can still
have a MIRP mini operation--if the surgeon is experienced in doing
parathyroid operations and is comfortable doing them. Almost ALL patients should be able to go home within
one or two hours of parathyroid surgery in 2004. If your surgeon is not
doing this, then find an expert! If your surgeon wants you to spend 2 or 3
days in the hospital after parathyroid surgery--RUN---and find another
surgeon! This doctor is still living in the 1970's and is not as
comfortable with this disease as he/she should be.
About 90 percent of all patients with parathyroid disease who are candidates for the
SMALLEST minimal
parathyroid operation--the 14 - 20 minute MIRP. As centers have gained more experience over the past
few years, this rate has climbed gradually.
Editor's Note: The author's institution (Norman
Parathyroid Clinic) is able to perform the minimal operation on
about 99 percent of all parathyroid patients. This rate is
due to their extensive experience in parathyroid surgery and the
volume of parathyroid patients they see. parathyroid
surgery at Norman parathyroid surgery clinic. parathyroid surgery, parathyroid
operation
parathyroid,
The
minimally invasive approach
to parathyroid surgery is performed using local anesthesia (or LMA anesthesia
which is a great advance, and most patients are sent home within 1 - 2 hours following the
operation. The same-day surgery rate should average better than 95
percent of ALL parathyroid patients, with very few (almost none!) sent home the following morning.
Depending
on the experience of the surgeon, sometimes those undergoing a
standard bilateral parathyroid operation
are
sometimes kept overnight (23 hour stay). It is becoming quite uncommon for patients to stay longer than 23 hours following routine standard
parathyroid surgery. But, underlying diseases and other conditions such as age greater than
~85 will increase the likelihood of staying longer. REMEMBER...the emphasis is on quality of care and
cure of the parathyroid disease, NOT on how fast the patient is sent home!
As stated above, if your surgeon keeps all patients in the hospital for 2
days (or more) to measure the calcium... then find another surgeon. Those
days are gone and your surgeon is not doing enough parathyroid surgery to
be comfortable with all of the newer techniques and the better ways to
manage this disease. (NOTE, The Norman Parathyroid Clinic keeps less than 2% of
patients overnight following a parathyroid operation... ALL TYPES of
parathyroid operations). Parathyroid surgery at the Norman Parathyroid
surgery clinic.
What if your hospital doesn't have a nuclear
probe like the one shown in this picture? These parathyroid probes have only become widely available during
the late 1990's. This is the probe that the surgeon uses in the
operating room to find the radioactive (over-active) parathyroid gland
(Read more about how this is done by clicking
here). Sometimes, a few surgeons will perform mini-parathyroid surgery without the
probe, but this should only be done by an experienced parathyroid
surgeon--one that does MORE THAN 100 parathyroid operations per year!!! The days of giving all parathyroid patients a big operation are gone! If
your surgeon intends to do a standard parathyroid operation without even
checking to see if you are a candidate for mini parathyroid surgery, go
somewhere else! To read more about the different cure
rates for surgeons with different levels of experience, go
to this page of Parathyroid.com. This is very interesting
information!
Bottom
line: Surgeons who perform only a few parathyroid operations per
year have a cure rate of approximately 85%. Surgeons who do more than
200 parathyroid operations per year have a cure rate of over 98%.
Complication rates are more than doubled as well for surgeons who operate
on parathyroid infrequently! Pick your surgeon
carefully!
