1000 minimally invasive parathyroidectomies without intra-operative XXXX measurement: lessons learned.

@entity1 @entity459 @entity2741 @entity1373 @entity3 @entity652 @entity461
BACKGROUND: @entity3 ( @entity3 ) has become the procedure of choice in the treatment of @entity459 where a single @entity652 can be localized preoperatively. The role for intra-operative @entity461 measurement (IOPTH) is controversial. Some experts recommend that IOPTH is a mandatory requirement for successful @entity3 while others state that the technique is not needed. We reviewed 10 years of @entity3 in a single unit without the use of IOPTH in order to examine causes of failure. METHODS: This study is a retrospective review of the University of Sydney Endocrine Surgery Database from May of 1998 to August of 2008. The database was queried for MIPs performed as well as for failed operations. @entity1 record analysis was completed to determine the reason for failure of the operation. RESULTS: In the period January 1998 to August 2008, a total of 2343 parathyroidectomy procedures were performed. Of these, 1020 were MIPs with 23 (2.2%) failures. One @entity1 was found to have benign familial @entity2741 , whereas five were lost to follow-up. Reasons for failure in the remaining 17 @entity1 were: 10 @entity1 (59%) were found to have double @entity652 , 3 (17%) @entity1 with @entity1373 and 4 (24%) @entity1 with single gland disease were missed at initial operation. All 17 were cured on repeat exploration. CONCLUSION: @entity3 can be performed safely and with 98% success without the need for IOPTH. The most common cause of failure after @entity3 is an occult double @entity652 . Given that repeat sestamibi scan correctly identifies persistent disease in most cases, consideration can be given to @entity3 as a choice of procedure for repeat operation.
