Download tumors of the thyroid, parathyroid and adrenal glands

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