2008 Annual Meeting Abstracts
Parathyroid devascularization: A novel operative technique in remedial parathyroid surgery
Tobias J. Carling, MD PhD, Patrica I. Donovan, RN, MBA, Robert Udelsman, MD MBA.
Yale University Medical School, New Haven, CT, USA.
Objective: To evaluate outcomes in primary hyperparathyroidism (pHPT) patients undergoing the surgical technique of ligating the end-artery blood to the occult missing parathyroid gland in selective, complex, remedial parathyroid operations.
Design: Prospective series.
Setting: University hospital.
Patients: 1444 patients (1990-2007) were explored for pHPT. Of these, 162 remedial explorations were performed in 160 patients.
Intervention: In 9 complex reoperations (8 patients), enlarged parathyroid glands were not identified despite extensive exploration. Ligation of the blood supply (ligation of the ipsilateral inferior thyroid artery as well as other arterial branches when appropriate) to the presumed missing parathyroid gland was performed, in order to devascularize the end-artery blood supply.
Main outcome measures: Intraoperative PTH (IOPTH), postoperative PTH and calcium levels.
Results: Three out of 5 patients achieved long term cure after parathyroid devascularization despite no evidence of parathyroid tissue upon histopathological analysis, whereas 2 patients had persistent pHPT. Reduction in IOPTH levels >50 % (range 59.7-86.1 %) was seen in all patients with long term cure. Follow up serum calcium (reference range: 8.8-10.2 mg/dl) and PTH (reference range: 10-65 pg/ml) levels in the three patients were 9.6 mg/dl and 25 pg/ml; 9.2 mg/dl and 59 pg/ml; 10.1mg/dl and 29 pg/ml at 72, 40, and 24 months, respectively.
Conclusions: Ligation of the parathyroid end-artery blood supply is a valuable operative technique of last resort in remedial parathyroid surgery. IOPTH normalization is indicative of long term cure.