Abstract | OBJECTIVE: To review the outcomes of 656 consecutive parathyroid explorations performed by a single surgeon and to compare the results of conventional and minimally invasive parathyroidectomy (MIP) techniques. SUMMARY BACKGROUND DATA: Traditional surgery for primary hyperparathyroidism (HPTH) involves bilateral cervical exploration, which is usually accomplished under general endotracheal anesthesia. The MIP technique involves preoperative localization with sestamibi scans, surgeon-administered cervical block anesthesia, directed exploration through a small incision, intraoperative rapid parathyroid hormone assay, and discharge within 2 to 3 hours of surgery. METHODS: Six hundred fifty-six consecutive patients with primary HPTH underwent exploration between January 1990 and March 2001. RESULTS: MIP was used with ever-increasing frequency beginning in March 1998. Four hundred one procedures (61%) were performed using the standard technique and 255 patients (39%) were selected for MIP. The success rate for the entire series was 98%, with no significant differences comparing traditional and MIP techniques. The overall complication rate of 2.3% reflects 3.0% and 1.2% rates in the standard and MIP groups, respectively. MIP was associated with approximately a 50% reduction in operating time, a sevenfold reduction in length of hospital stay, and a mean cost savings of $2,693 per procedure, which represents nearly a 50% reduction in total hospital charges. CONCLUSIONS: A dramatic and sustained shift has occurred in the surgical treatment of primary HPTH: MIP has replaced traditional exploration for most patients.
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Authors | Robert Udelsman |
Journal | Annals of surgery
(Ann Surg)
Vol. 235
Issue 5
Pg. 665-70; discussion 670-2
(May 2002)
ISSN: 0003-4932 [Print] United States |
PMID | 11981212
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Radiopharmaceuticals
- Technetium Tc 99m Sestamibi
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Topics |
- Cost Savings
- Databases, Factual
- Female
- Hospital Charges
- Humans
- Hyperparathyroidism
(diagnostic imaging, epidemiology, surgery)
- Length of Stay
(statistics & numerical data)
- Male
- Middle Aged
- Minimally Invasive Surgical Procedures
(economics, statistics & numerical data)
- Outcome and Process Assessment, Health Care
- Parathyroidectomy
(economics, methods)
- Preoperative Care
- Prospective Studies
- Radionuclide Imaging
- Radiopharmaceuticals
- Technetium Tc 99m Sestamibi
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