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SurgeryNews SPOTLIGHT ON SURGICAL ONCOLOGY Minimally Invasive PARATHYROID Surgery JENNIFER L. MARTI, MD Attending Endocrine Surgeon Two percent of post-menopausal women are diagnosed with hyperparathyroidism and more may be undiagnosed. In the vast majority of cases, one of the four parathyroid glands is enlarged. This single adenoma lends itself well to minimally invasive parathyroidectomy (MIP). In the hands of a skilled endocrine surgeon, this minimally invasive approach has a 98 percent success rate. Primary hyperparathyroidism is diagnosed from a blood test. The parathyroid gland secretes excessive hormone, which results in a rise in the blood calcium levels. Hyperparathyroidism puts patients at risk for osteoporosis, kidney stones, depression and fatigue. Historically, removal of the enlarged gland was accomplished by making a long, 8 to 10 cm incision, through which the surgeon then examined all four glands in search of the affected, enlarged gland. This surgical approach potentially increased the risk of injury to the nerves to the vocal cords and the other three unaffected parathyroid glands. MIP is now possible due to advances in preoperative imaging and operating room technology, which allow very targeted surgery. Preoperative imaging demonstrates which gland is enlarged. Removal of the affected gland is then accomplished through a small one-inch (3 cm) incision. Intraoperative blood tests, which can detect the drop in parathyroid hormone (PTH) levels, confirm successful removal of diseased glands. The PTH A close look at the minimally invasive parathyroid procedure. has a short half-life, so it only takes minutes to detect a drop of the hormone levels to within the normal range. In most cases, minimally invasive parathyroidectomy surgery is performed under local anesthesia with mild sedation as a same-day ambulatory procedure. The smaller incision results in less postoperative pain, less complications and less scarring. As with most minimally invasive approaches, the technique’s advantages enable the patient to return to normal life routines quickly. Endocrine surgery is a newer subspecialty that falls under the Division of Surgical Oncology at Beth Israel Medical Center, as it does in most academic centers. At Beth Israel Medical Center, endocrine surgery focuses on thyroid, parathyroid and adrenal gland diseases. To refer a patient or request a consult for thyroid or adrenal disease, please call 212.844.6234. www.BISurgery.org