Chirurgie parathyroïdienne dirigée: Une série de 100 patients consécutifs

Introduction: The treatment of primary hyperparathyroidism has long required a bilateral neck exploration to localize all parathyroid glands. New techniques in pre-operative imaging (technetium-99m-sestamibi scanning, high resolution ultrasonography) have allowed an accurate localization of pathological glands. Moreover, the intraoperative intact parathyroid hormone assay (iPTH) now permits to confirm the resection of all hyper-secreting glands. Material and methods: Two hundred and twenty patients underwent parathyroid operations during the last 3 years, by different minimally invasive techniques. Pre- and intra-operative data, as well as the follow-up were recorded prospectively. The results of the last 100 unilateral approaches, performed for primary hyperparathyroidism, were analyzed. Results: There were 78 women and 22 men, with a mean age of 57 ± 15 years (25 to 92 years). Mean operative time was 44 ± 25 min. Ninety-three solitary adenomas, three double adenomas, three carcinomas and one hyperplasia were resected. Two patients required a bilateral exploration. There was one intra-operative complication (pneumothorax) during the resection of a mediastinal gland. Three post-operative complications occurred, with 2 hematomas and one transient recurrent laryngeal nerve paralysis. Median hospital stay was 2 ± 7,5 hours (1 -72 hours). All patients were cured following the operation, as predicted by the intra-operative iPTH assays. Conclusion: These results suggest that unilateral, targeted, neck explorations offer a cure rate similar to those obtained by bilateral neck explorations. Moreover, this operation can be performed under local anesthesia, with a short hospital stay and recovery time. The morbidity rate is low but should be addressed by large-scale comparative studies.