A number of advances have been made in parathyroid surgery over the past 15-20 years that allow very quick and successful parathyroid operations. As you will learn from this app as well as every other source on the topic, surgeon experience is very important for a successful parathyroid operation.
Mini-parathyroid surgery can be performed on virtually every patient with primary hyperparathyroidism, but this is very dependent upon the skill and experience of your surgeon. Some surgeons require a positive scan of some form (like a sestamibi scan or ultrasound scan) before they will agree to perform a mini-parathyroid surgery. Other surgeons with considerably more experience will perform mini-parathyroid surgery on every patient, even those with negative scans. Scan results are not nearly as important as surgeon experience. In fact, large studies have shown that surgeons who rely heavily on scan results have a lower cure rate.
A mini-parathyroid operation should be able to be performed through a one inch (2.5 cm) incision in most people, but this will be a slightly larger incision for people who are considerably over weight. Often, mini-parathyroid surgery does not require general, endotracheal anesthesia, but again, the experience of the surgeon is important even for the type of anesthesia used. Mini-parathyroid surgery should be able to be completed in less than 1 hour. The most experienced surgeons can routinely perform this operation in less than 20 minutes. Almost all patients undergoing a mini-parathyroid surgery should expect to be sent home from the hospital within 2.5 hours of the operation.
It is important for your surgeon to make every attempt to determine you are cured before concluding your operation. As a reminder, about 30% of people with primary hyperparathyroidism will have more than one parathyroid tumor, so the surgeon must make an effort to determine that you do not have more than one tumor. By far the best way to do this is for the surgeon to examine all four glands, but this can be very hard for inexperienced surgeons. Therefore, the more inexperienced surgeons who cannot safely and quickly find all four parathyroid glands will instead measure the amount of PTH hormone in your blood and use this measurement to estimate if you have a second tumor. This test (called intraoperative PTH assay) has a known error rate of 10 to 18%. Therefore, an operation that uses intraoperative PTH measurement to determine if you are cured (and don’t have a second parathyroid tumor) instead of actually checking the other glands will be unsuccessful operation at least 10% of the time. A number of scientific publications show that patients who have only one parathyroid gland examined and intraoperative PTH levels measured will have about 8% chance of needing another operation within 1 year, and a 15% chance of needing a second operation within 10 years. The surgeon experts behind this app find this high failure rate unacceptable and believe that the measurement of PTH levels during an operation causes as many problems as it solves and is over emphasized by surgeons with little or modest experience. As an alternative, the most experienced surgeons will typically choose to examine all four parathyroid glands at the time of the initial operation even though this is done through a very small incision (see the operation video in the Video Library). Advanced techniques (the MIRP mini-parathyroid operation) allows these surgeons to measure the amount of hormone produced by each parathyroid gland during an operation. This is very different from intra-operative PTH assay. The method of looking at all four parathyroid glands typically has a failure rate of less than 1% when performed by an expert.
Mini-parathyroid surgery is appropriate for virtually every patient with hyperparathyroidism, but the size of the operation, the duration of the operation, and the rate of complications is primarily dependent upon the skill and experience of the surgeon. The most successful surgeons will assess all four parathyroid glands so the patient has the highest chance of cure and the lowest chance of needing a second operation. This can be done in a very quick, minimally invasive fashion.
For more information on this topic: http://www.parathyroid.com/mini-surgery.htm