Bilateral neck exploration for parathyroidectomy under local anesthesia: a viable technique for patients with coexisting thyroid disease with or without sestamibi scanning.

Background: Bilateral neck exploration (BNE) with the patient under general anesthesia has been the standard for parathyroidectomy. In efforts to minimize invasiveness and recovery from the procedure, unilateral neck exploration with the patient under local anesthesia in combination with sestamibi scanning is being done. Patients with a nonlocalized adenoma, concurrent thyroid disease, and/or multiple parathyroid adenomas have been excluded from this minimally invasive procedure.

Methods: Two hundred thirty-six patients underwent BNE under local anesthesia for primary hyperparathyroidism that was performed by a single surgeon between 1988 and April 1999.

Results: The percentage of patients who underwent parathyroidectomy under local anesthesia increased from 3% in 1988 to 97% in 1999. Twenty-three percent of patients underwent a concurrent thyroid procedure, and 84% of patients had a single adenoma removed. Sixty-two percent of patients had a negative preoperative sestamibi scan or did not have a scan at all. The incidence of frozen section decreased in the initial 50 cases from 100% to 39% during the last 100 cases. Average operative time was 43 minutes without a thyroid procedure and 66 minutes with a thyroid procedure. Overall, 70% of patients were discharged within 6 hours of the surgical procedure; this percentage increased to 91% during the last 5 months.

Conclusions: BNE with the patient under local anesthesia can be performed safely and effectively in patients with coexisting thyroid disease and a nonlocalized adenoma.