Minimally invasive parathyroidectomy: 50 consecutive cases

Objective: To determine the effectiveness and outcomes of minimally invasive parathyroidectomy. Design: Prospective, non-randomised, non-blinded trial. Settings: Affiliated university teaching hospitals of the Northern Clinical School. University of Sydney, New South Wales, May 1998 to October 1999. Patients: 50 consecutive patients who underwent minimally invasive parathyroidectomy for primary hyperparathyroidism, and 150 consecutive patients undergoing open parathyroidectomy over the same period. Results: Minimally invasive parathyroidectomy was successfully completed and resulted in cure (normocalcaemia) in 42 of 50 patients (84%). Seven patients (14%) required conversion to an open procedure, all of which also resulted in normocalcaemia, giving an overall cure rate of 98%. One patient had persistent hyperparathyroidism after minimally invasive parathyroidectomy which was cured at subsequent open reoperation. Three patients had a temporary recurrent laryngeal nerve palsy. Open parathyroidectomy was successful in 147 of 150 patients (98%) at initial operation; one patient had a temporary recurrent laryngeal nerve palsy. Intraoperative measurement of parathyroid hormone levels by a quick technique in 23 of the patients (13 having minimally invasive and 10 open procedures) correctly identified the presence of multiple-gland disease. Conclusion: Minimally invasive parathyroidectomy is a feasible procedure, although there are concerns about the complication rate.