Minimally invasive parathyroidectomy under local anesthesia in connection with ultrasonography, sestamibi scintigraphy and intra-operative parathormone measurement

Introduction: The standard procedure in patients with primary hyperparathyroidism (pHPT) includes cervical exploration and identification of all four enlarged parathyroid glands. New localization techniques, i.e., ultrasonography associated with color duplex sonography, Tc-99m-sestamibi scintigraphy and the possibility of intraoperative parathormone (iPTH) measurement permit minimally invasive parathyroidectomy (MIP). Three different methods have been established: minimally invasive open parathyroidectomy, endoscopic parathyroidectomy and video-assisted parathyroidectomy. We present our experience with open MIP with the patient under local anesthesia (LA). Methods: In 25 patients with pHPT the operation was started under local anesthesia. Preoperatively, ultrasonography and sestamibi scintigraphy were performed in each patient. iPTH measurement was carried out intraoperatively. Results: In 23 patients (92%) the operation was done successfully in LA. There were no postoperative complications. During follow-up none of the patients developed hypercalcemia again. Conclusion: MIP in connection with ultrasonography, sestamibi scintigraphy and intraoperative PTH measurement offers a promising treatment for patients with pHPT.