Is minimally invasive parathyroidectomy reasonable in the nonuniversity setting?

Background: Minimally invasive parathyroidectomy (MIPX) hinges on accurate preoperative localization and the intraoperative parathyroid hormone (IOPTH) assay to confirm adequate resection. Our goal was to evaluate the results of this technique when applied in a nonuniversity setting.

Methods: All patients undergoing parathyroidectomy at our institution from August 2000 until June 2005 were retrospectively reviewed. Patients were divided into 2 groups: bilateral cervical exploration versus MIPX based on adequate preoperative localization.

Results: There were 271 patients who underwent parathyroidectomy during the study period. Of these cases, 204 patients with primary hyperparathyroidism composed our study group. We observed that 136 patients (67%) had unilaterally positive localization studies (group 1), and MIPX was successfully completed in 52% of cases.

Conclusions: Although nearly all patients with single-gland disease should be candidates for MIPX, we found that adequate preoperative imaging and concurrent thyroid disease limited successful completion of the minimally invasive procedure.