Clinical outcomes and fiscal consequences of bilateral neck exploration for primary XXXX without preoperative radionuclide imaging or minimally invasive techniques.

@entity1 @entity845 @entity66 @entity5 @entity1373 @entity460 @entity3243 @entity652 @entity2742
BACKGROUND: Radionuclide imaging-directed, minimally invasive parathyroid operation is promoted in the surgical literature and public domain as the fastest, most successful, and cheapest means of treating primary @entity2742 . The validity of these claims is unproven. This study reviews the treatment outcome results of a large series of @entity1 treated with standard parathyroid operation without preoperative localization studies. Cost comparisons are made between this series and previous reports of selected @entity1 in whom preoperative radionuclide imaging preceded minimally invasive parathyroid operation. METHODS: Diagnosis, treatment, and outcome data for 688 consecutive @entity1 undergoing first neck exploration for primary @entity2742 were prospectively collected. All @entity1 in our series underwent standard bilateral neck exploration without preoperative localization studies. Intraoperative @entity845 blue was used to aid identification of all parathyroid glands. Surgical findings, pathological diagnosis, operative time, length-of-stay, and treatment success data were collected. Cost data were calculated for our series using the identical calculations used in previous reports. Our outcome and calculated cost data were compared with previous reports by centers advocating scan-directed, minimally invasive parathyroid operation. RESULTS: Of 2,752 predicted total glands, 2,520 (91.6%) were identified using standard neck exploration without radionuclide localization studies. Single @entity652 , with at least 1 normal gland, was found in 542 @entity1 (78.8%), with 8 in a fifth gland. @entity1373 was identified in 98 @entity1 (14.2%) and of these 22 (3.2%) were double @entity652 . Ten @entity1 had @entity3243 (1.5%), and all received definitive surgical treatment during the primary operation. Cure rates were assessed by measurement of normal serum @entity460 and parathyroid hormone levels at 3 and 12 months after operation, and were 97.7% in our series. Mean operating time for the entire series was 65 minutes, decreased to 35 minutes in @entity1 with single @entity652 , and mean recovery room time was 30 minutes. Mean total costs for @entity1 undergoing standard exploration for single @entity652 was US dollars 1,107, and increased to US dollars 1,243 when @entity1 with @entity66 , @entity1373 , or @entity5 were included. CONCLUSIONS: Our series demonstrates operative times and treatment outcomes with costs that are approximately one-third less than those for scan-directed, minimally invasive operation for primary @entity2742 . Thus, claims that scan-directed parathyroid operation is the cheapest, fastest, and most successful means of treatment are not supported by these data.
