MINIMALLY
INVASIVE PARATHYROIDECTOMY (MIP) IN PRIMARY HYPERPARATHYROIDISM (PHPT)
Recent
advances in modern imaging allow accurate preoperative localization of the
hyperfunctioning parathyroid tissue in patients with PHPT. In most cases (~ 85
%), PHPT is due to a solitary parathyroid adenoma, while in about 2 – 5 % to a
double adenoma. The two most commonly used imaging methods for preoperative
localization are neck ultrasonography and Tc99m-sestamibi scan. Concordant
results of these localization studies allow the minimally invasive approach
(minimally invasive parathyroidectomy [MIP]), which has several advantages over
the bilateral neck exploration used in the past, including:
-Lesser
incision
-Better
cosmetic outcome
-Less
extensive tissue injury
-Less pain
-Lesser morbidity
MIP should
be considered as the surgical approach of choice for patients:
·
with
positive preoperative localization studies undergoing first-time surgery
·
who
have no family history of primary hyperparathyroidism
·
who
have no concomitant thyroid pathology requiring surgery
·
who
are not on lithium therapy
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