scholarly journals Preoperative parathyroid harpoon localisation: a new technique helpful in reoperative patients with persistent hyperparathyroidism

2013 ◽  
Vol 95 (2) ◽  
pp. e1-e2
Author(s):  
J Gómez-Ramírez ◽  
D Tagarro ◽  
JM Bravo ◽  
E Martín-Pérez ◽  
E Larrañaga
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Conservative Surgery ◽  
New Technique ◽  
Reoperative Surgery ◽  
Abnormal Parathyroid Gland ◽  
Persistent Hyperparathyroidism ◽  
A New Technique ◽  
Ultrasonography Guidance ◽  
Inexpensive Technique

Surgery for persistent primary hyperparathyroidism remains a major challenge for surgeons and these reoperative procedures require an experienced parathyroid surgeon. The goal of reoperative surgery is to excise the abnormal parathyroid gland(s) and limit exploration to help minimise the potential complications. At least two positive and concordant localising studies should be available before reoperation because the technical difficulties in these cases make an exact localisation necessary before surgery. We describe the placement of a metallic harpoon under ultrasonography guidance as a safe, simple and inexpensive technique for localisation of the enlarged gland prior to conservative surgery.

scholarly journals Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
S. Helme ◽  
A. Lulsegged ◽  
P. Sinha
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Parathyroid Tissue ◽  
Neck Surgery ◽  
Safe Procedure ◽  
Preclinical Phase ◽  
Abnormal Parathyroid Gland ◽  
Parathyroid Disease ◽  
History Of

Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

Problems with Reoperation of the Parotid Gland and Facial Nerve

1988 ◽  
Vol 99 (5) ◽  
pp. 480-488 ◽  
Author(s):  
John J. Conley
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Clinical Observation ◽  
Biological Process ◽  
Conservative Surgery ◽  
Benign Disease ◽  
New Technique ◽  
The Status ◽  
A New Technique

The decision as to how to handle recurrent benign disease in the parotid gland can be a perplexing problem. It may cover the gamut of clinical observation, through conservative surgery to radical ablation. The situation is a balance between the nature of the biological process, the possibility of cure or control, and the status of the facial nerve. These problems can be exceptionally difficult in analysis and philosophical management, and are frequently pinioned between technical craftsmanship, curability, and deformity. An understanding, however, of the variety of possibilities—and particularly their relationship to the facial nerve—will help to position these cases within the realm of surgical reality. A new technique of interfascicular dissection is proposed in certain instances.

scholarly journals Adenomyosis: Difficult to Diagnose, and Difficult to Treat

2001 ◽  
Vol 7 (2) ◽  
pp. 89-95 ◽  
Author(s):  
C. Wood
Keyword(s):  
Drug Therapy ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Conservative Surgery ◽  
New Technique ◽  
Artery Embolization ◽  
A New Technique

Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Danazol IUD has been shown to reduce symptoms. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in more than 50% of patients, although follow up has been restricted to three years. Arterial uterine artery embolization is a new technique which may be tried before considering hysterectomy. Hysterectomy may still be necessary in severe cases of adenomyosis.

scholarly journals Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

2015 ◽  
Vol 97 (8) ◽  
pp. 598-602 ◽  
Author(s):  
CJ McIntyre ◽  
JLY Allen ◽  
VA Constantinides ◽  
JE Jackson ◽  
NS Tolley ◽  
...  
Keyword(s):  
Cure Rate ◽  
Tertiary Referral Centre ◽  
Reoperative Surgery ◽  
Initial Surgery ◽  
Parathyroid Hormone Monitoring ◽  
Abnormal Parathyroid Gland ◽  
Persistent Hyperparathyroidism ◽  
Intraoperative Parathyroid Hormone ◽  
Rate Of Failure ◽  
Recurrent Hyperparathyroidism

Introduction Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, ‘persistent disease’ is defined as the situation where the patient has not been cured by the first operation. The term ‘recurrent hyperparathyroidism’ is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence. Methods Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation. Results Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease. Conclusions Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.

scholarly journals Preventing blind thyroid lobectomy in patients with intrathyroidal hyperfunctioning parathyroid glands with radioguided enucleation

2020 ◽  
Vol 7 (1) ◽  
pp. IJE28
Author(s):  
Sophie Dream ◽  
Brenessa Lindeman ◽  
Herbert Chen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Gamma Probe ◽  
Parathyroid Glands ◽  
Radioguided Surgery ◽  
Thyroid Lobectomy ◽  
Abnormal Parathyroid Gland ◽  
Thyroid Parenchyma

Aim: Hyperfunctioning intrathyroidal parathyroid glands are rare and often result in thyroid lobectomy. This study examines the utility of radioguided surgery to guide enucleation of intrathyroidal parathyroids. Methods: Between December 2002 and March 2018, 2291 patients underwent parathyroidectomy by one surgeon for primary hyperparathyroidism. A total of 74 (3%) patients had an ectopic intrathyroidal parathyroid gland and underwent radioguided. Results: All of intrathyroidal parathyroid glands were localized with the gamma probe. In vivo radionuclide counts were above 120% of the background in all but three patients. All intrathyroidal parathyroids were enucleated with the guidance of the gamma probe. Conclusion: Radioguided surgery is useful for intraoperative identification of hyperfunctioning, intrathyroidal parathyroid glands. This technique allows for enucleation of the abnormal parathyroid gland, avoiding thyroid lobectomy and preserving healthy thyroid parenchyma.

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