Conventional parathyroidectomy versus noninstrumental minimally invasive parathyroidectomy in parathyroid adenoma

In recent years, minimally invasive parathyroidectomy (MIP) is frequently preferred in treating primary hyperparathyroidism (PHPT). The aim of this study was to compare the results obtained using MIP with no instrument and those after conventional parathyroidectomy (CP) in patients with single parathyroid adenoma (SA).
Patients who underwent surgery with SA diagnosis between January 2010 and June 2017 were analyzed retrospectively. Patients with the preoperative multiglandular disease were not included in the study. The patients with SA diagnosis were divided into two groups according to the type of surgery they underwent: MIP and CP. Their demographic characteristics; duration of surgery; preoperative and postoperative parathormone (PTH), calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) values; localization study results; and pathological diagnosis were compared.
A total of 74 patients were operated for SA. Further, 42 (56.7%) of the patients were operated with the MIP technique and 32 (43.2%) with the CP technique. The mean age of the patients was 52.0 ± 12 years for MIP and was 56.7 ± 12 years for CP. The mean operative time was 66.1 ± 27.3 min for MIP and 106.5 ± 44.6 min for CP. The success rate was 92.8% for MIP and 100% for CP. Neck ultrasonography (USG) and parathyroid scintigraphy (PS) were performed on all patients for preoperative diagnosis and localization. The accuracy rates were 66.2% for USG and 89.1% for PS. No significant difference was found between USG and PS sensitivity with regards to adenoma diameter. The mean follow-up period was 13.2 ± 9.7 months (range 3–32 months).
MIP is an appropriate surgical choice in SA treatment if preoperative localization studies are performed at a proper and adequate level. In MIP, the success rate of the surgery increases significantly in parallel with the increase in the performing team's experience.