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The Superiority of Minimally Invasive Parathyroidectomy Based on 1650 Consecutive Patients With Primary Hyperparathyroidism

Udelsman, Robert MD, MBA, FACS*; Lin, Zhenqiu PhD; Donovan, Patricia RN, MBA*

doi: 10.1097/SLA.0b013e318208fed9
Original Article

Objective: To compare the results of minimally invasive parathyroidectomy (MIP) and conventional parathyroid surgery.

Background: Primary hyperparathyroidism is a common endocrine disorder often treated by surgical intervention. Outpatient MIP, employing image-directed focused exploration under cervical block anesthesia, has replaced traditional surgical approaches for many patients with primary hyperparathyroidism. This retrospective review of a prospective database compared MIP with conventional parathyroid surgery.

Methods: One thousand six hundred fifty consecutive patients underwent surgery for primary hyperparathyroidism by a single surgeon between 1990 and 2009 at 2 tertiary care academic hospitals. Conventional bilateral cervical exploration under general anesthesia was performed in 613 patients and MIP was performed in 1037 cases. Cure rates, complication rates, pathologic findings, length of hospital stay, and total hospital costs were compared.

Results: Minimally invasive parathyroidectomy is associated with improvements in the cure rate (99.4%) and the complication rate (1.45%) compared to conventional exploration with a cure rate of 97.1% and a complication rate of 3.10%. In addition, the hospital length of stay and total hospital charges were also improved compared to conventional surgery.

Conclusions: Minimally invasive parathyroidectomy is a superior technique and should be adopted for the majority of patients with sporadic primary hyperparathyroidism.

One thousand six hundred fifty consecutive patients underwent minimally invasive parathyroidectomy (N = 1037) or conventional exploration (N = 613) for primary hyperparathyroidism. Minimally invasive parathyroidectomy is associated with improvements in cure (99.4%) and complication rates (1.45%) compared to conventional exploration with a cure rate of 97.1% and a complication rate of 3.10%. In addition, the hospital length of stay and total hospital charges were also improved.

From the *Department of Surgery, Yale University School of Medicine, †Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06525.

The authors have nothing to disclose regarding this research.

Reprints: Robert Udelsman, MD, MBA, FACS, Department of Surgery, Yale University School of Medicine, Yale-New Haven Hospital, P.O. Box 208062, New Haven, CT 06520-8062. E-mail: Robert.udelsman@yale.edu.

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