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What is a minimally invasive parathyroid surgery?
Minimally invasive parathyroid surgery is a procedure in which the parathyroid gland is removed through a small incision.
The procedure is usually performed using a video-assisted or endoscopic camera, where the surgeon uses a camera to magnify the view to remove the affected gland. Minimally invasive parathyroid surgery is usually considered in the following cases:
- Only if one parathyroid gland is affected (The parathyroid is made of four tiny glands that usually sit next to or behind the thyroid gland).
- The affected gland should be less than 3 cm in diameter and should not be malignant (cancer).
- The patient should also not have any thyroid disease and previous radiation therapy of the head and neck area.
The procedure is usually done under local anesthesia, and patient vitals are monitored throughout the process:
- Prior to the surgery, the patient may receive a shot of a very small amount of radioactive tracer. This helps highlight the diseased glands.
- During this surgery, the surgeon may make small incisions (cuts) on one side of the neck or chest and armpit (underarm).
- The surgeon usually uses special tools, a hand-held probe (wand), or a laparoscope to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives the surgeon a clear view of the neck area while watching the images on a monitor.
- Through the small incisions, the tools are sent toward the highlighted diseased glands, and then the surgeon removes the diseased gland through it.
- The incisions are usually around 2-3 cm long and are closed with dissolving sutures and then taped with a micropore.
- The procedure is usually completed within an hour.
Reasons and benefits for the procedure
The most common condition of the parathyroid glands is overactivity of the parathyroid gland (hyperparathyroidism). This involves an overproduction of parathyroid hormone (PTH) regardless of the amount of calcium in the blood. Hyperparathyroidism is often caused by a noncancerous tumor on the parathyroid gland, known as an adenoma, which causes the gland to enlarge and secrete the PTH. Symptoms of hyperparathyroidism include:
- Kidney stones
- Frequent headaches
- Chronic fatigue
- Depression
- Pain in bones (usually the arms and legs)
- High blood pressure
- Inability to concentrate (forgetfulness)
- Trouble sleeping (taking frequent naps without feeling refreshed)
Hyperparathyroidism causes problems that involve
- Bones
- Muscles
- Skin
- Nerve endings
- Kidney
Benefits of minimally invasive parathyroid surgery
This procedure is referred to as a “minimally invasive parathyroidectomy” and has the following advantages for patients:
- Less post-operative pain
- Small or barely visible scar
- Faster recovery from surgery
- Shorter hospital stay
- Quick return to work and other routine activities
- Less blood loss and scarring
- Less risk of infection and postoperative complications
The incision is sealed with glue that will peel off within a week.
What are risks and complications of the surgery?
- Less than 1% of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which may affect speech.
- Patients requiring more extensive surgery could develop hypoparathyroidism, resulting in low calcium levels, which may require treatment with calcium or vitamin D.
- Anesthesia complications and surgical complications are considered rare due to minimally invasive techniques.
Recovery times after minimally invasive parathyroidectomy
- Minimally invasive parathyroid surgery is usually performed as a day surgery or an overnight stay procedure.
- Most people recover fairly quickly after minimally invasive parathyroidectomy and resume normal activities within 1 week.
- A postoperative visit at 2-3 weeks is routine to review the results.
- A visit should be made at 2-3 weeks for a wound check.
- Α final surgical review should be done at 3 months.
- Patients on calcium supplements need to see a doctor on weekly basis to monitor blood calcium levels and titrate the calcium supplement dosage.
- Endocrinology review is needed 2-3 months after surgery for progress monitoring.
Calcium supplements:
- After successful parathyroid surgery where two or more glands are preserved, the calcium level falls to normal very quickly.
- A temporary drop in calcium levels below normal also sometimes occurs.
- Symptoms of a low calcium level may include tingling around the mouth and in the hands, cramping (“tetany”) of the hands and feet.
- Patients with a low calcium level after parathyroidectomy are put on calcium supplements.