• Parathyroidectomy—Minimally Invasive

    (Parathyroid Gland Removal—Minimally Invasive; Video-assisted Parathyroidectomy; Endoscopic Parathyroidectomy; Radio-guided Parathyroidectomy; Parathyroidectomy, Video-assisted; Parathyroidectomy, Endoscopic; Parathyroidectomy, Radio-guided)

    Definition

    A parathyroidectomy is a surgery to remove abnormal parathyroid glands. There are four parathyroid glands located in the neck. The glands make parathyroid hormone, which is used to control calcium levels in the blood.
    Parathyroid Glands and Thyroid Glands (Back View)
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    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    The surgery is done to remove one or more abnormal parathyroid glands. The glands can be abnormal due to cancer or for other reasons.
    A minimally invasive approach is usually done if only one gland needs to be removed. If more than one gland needs to be removed or if the doctor needs to do additional surgery in the neck, she may use a conventional approach instead, which involves making larger incisions.

    Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have a parathyroidectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Hoarseness
    • Low calcium levels in the blood
    • Wound infection
    • Reaction to the anesthesia
    • Skin tethering—tissues and skin may become attached to the voice box or windpipe
    • Scarring
    • Blocked airway
    • Damage to nerves (which can cause problems like paralyzed vocal cords)
    Factors that may increase the risk of complications include:
    Talk to your doctor about these risks before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor will:
    • Do a physical exam and ask you about your medical history
    • Order imaging scans (eg, ultrasound)
    • Have blood tests done
    You should:
    • Arrange to have someone drive you home from the hospital after surgery.
    • Avoid eating or drinking 6-8 hours before surgery.
    • Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
      • Blood-thinning drugs, such as warfarin (Coumadin)
      • Anti-platelet drugs, such as clopidogrel (Plavix)

    Anesthesia

    General anesthesia will be used. It will block any pain. You will stay asleep through the surgery. In some cases, local anesthesia may also be used.

    Description of the Procedure

    There are different types of minimally invasive surgeries that may be used, such as:
    Video-assisted Parathyroidectomy (Endoscopic Parathyroidectomy)
    The doctor will make a 1¼ inch (3 centimeter) cut in the neck. She will then insert a scope with a tiny camera attached. This camera will send images to the TV monitors. The doctor will rely on these images to find the abnormal gland.
    Radio-guided Parathyroidectomy
    The doctor will inject a radioactive substance into your body. The abnormal gland, and not the healthy ones, will absorb the substance. The doctor will then make a 1 inch (2½ centimeter) cut in the neck. She then will insert a small probe. The probe will detect signals that are given off by the radioactive substance. This will help the doctor find the abnormal gland.
    Once the gland has been removed, the doctor will close the area with stitches.

    How Long Will It Take?

    Between 30 minutes and 1-2 hours (depending on the type of surgery)

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. After the surgery, you may feel like you have a cold or sore throat . Your doctor will give you pain medicine.

    Average Hospital Stay

    This procedure is most commonly done in a hospital setting. If so, the usual length of stay is one day. It may be possible to leave the hospital on the same day of the procedure. Ask your doctor if this is an option for you. But, if you have any problems, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    The hospital staff will:
    • Observe you in the recovery room
    • Check on your ability to swallow and speak
    • Show you how to change your dressings and care for your wound
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • You may be given calcium supplements.
    • Check your wound daily for signs of infection.
    • You may want to eat semi-solid foods, like ice cream or oatmeal, for the first few days. These types of foods will be easier to swallow.
    • Be sure to follow your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Tingling or numbness in the fingertips, toes, hands, or around the mouth
    • Twitching or cramping of muscles
    • Redness, warmth, drainage, or swelling around the area where surgery was done
    • Difficulty swallowing, talking, or breathing
    • Signs of infection, including fever and chills
    In case of an emergency, call for medical help right away.

    RESOURCES

    The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) http://www.entnet.org/

    The American Association of Endocrine Surgeons http://www.endocrinesurgery.org/

    National Cancer Institute http://www.cancer.gov/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Canadian Society of Otolaryngology http://www.entcanada.org/

    References

    Farndon JR. Postoperative complications of parathyroidectomy. In: Holzheimer RG, Mannick JA. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich, Germany: Zuckschwerdt; 2001. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967/ . Accessed February 19, 2011.

    Miccoli P, Berti P, Conte M, Raffaelli M, Materazzi G. Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases. J Am Coll Surg. 2000;191(6):613-618.

    Parathyroid surgery. The American Association of Endocrine Surgeons website. Available at: http://www.endocrinesurgery.org/patient%5Feducation/parathyroid/surgery%5Foverview.shtml . Accessed February 19, 2011.

    Parathyroidectomy. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc%5Fname=Parathyroidectomy&content%5Fid=274 . Updated February 18, 2011. Accessed February 19, 2011.

    Parathyroidectomy. Cedars-Sinai website. Available at: http://acromegalysupport.org/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Parathyroidectomy.aspx . Accessed February 19, 2011.

    Parathyroidectomy: minimally invasive (focused). University of California, Los Angeles Endocrine Surgery website. Available at: http://endocrinesurgery.ucla.edu/surgery%5Fmip.html . Accessed February 21, 2011.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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