PARATHYROID GLAND DISEASES Primary hyperparathyroidism Hypoparathyroidism.
Parathyroid gland surgery
-
Upload
cardiacinfo -
Category
Documents
-
view
173 -
download
3
Transcript of Parathyroid gland surgery
![Page 1: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/1.jpg)
Journal Club March 2000
James French
![Page 2: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/2.jpg)
Bilateral Oblique Approach to Parathyroid Glands
Philippee C. J. Chaffanjon et al
• Objective To propose a simple and minimally invasive approach to parathyroid surgery
• Method A report of 20 years experience of an alternative surgical technique for parathyroid surgery
![Page 3: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/3.jpg)
Introduction
• History: Usual approach is low transverse
cervical incision
• Alternate approach to recent interest in minimally invasive endoscopic techniques
![Page 4: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/4.jpg)
Operative technique
• Supine position• 2 symmetrical
incisions, 2cm above and medial SC joint
• Skin, superficial fascia and platysma are cut without elevation and the deep fascia incised along SCM
![Page 5: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/5.jpg)
Op technique
• Omohyoid muscle exposed
• IJV visible along with efferent nerves of ansa cervicalis
• Pretracheal fascia incised parallel to the carotid sheath
![Page 6: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/6.jpg)
Op technique
• Retractors are used to separate the sheath from the infrahyoid muscles. This may be restricted by the middle thyroid vein which can be ligated
• The visceral sheath is opened close to the thyroid gland and the medial retractor lifts the lobe to expose the posterior side
![Page 7: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/7.jpg)
Op technique• The inferior thyroid artery
x’s the background and can be dissected out to help expose the recurrent laryngeal nerve
• It is possible to explore the arterial pedicles, thymus, and oesophagus with traction and counter traction using the retractors
![Page 8: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/8.jpg)
Method and Material
• Cases between 1976-1997
• 430 patients with primary hyperparathyroidism
• 167 patients with secondary or tertiary hyperparathyroidism
• Bilateral suction drainage was used for 10 years
• Selective draining for next 10 years
![Page 9: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/9.jpg)
Results
• Mean operating time 62 mins for 10
• 87mins for 20
• Drainage in 26.3% of cases
• Mean post op stay 2.8 days
• 83% single adenomas• Double adenomas 3%• Hyperplasia in 14%• MEN 13%
![Page 10: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/10.jpg)
Morbidity and Mortality
![Page 11: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/11.jpg)
Discussion
• Use bilateral approach as no pre-operative imaging
• High rate of morbidity due to re-operation
• Allows access to unusual locations of parathyroid glands
• Able to perform a thyroid lobectomy if necessary
• Similar results as presented in the literature
• Cosmetically good result• Low rates of bleeding and
infection
![Page 12: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/12.jpg)
Discussion cont.
• Future thyroid surgery able to be performed though standard incision with out scarring
• Low RLN injury rate• Low ansa cervicalis
injury rate
• Avoids potential morbidity of subcutaneous emphysema of the cercvicoscopic approach
• Decrease pain
![Page 13: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/13.jpg)
Comments
• Not a randomised series comparing two techniques
• ? Retrospective ? Prospective audit
• ? Level of training of surgeons
• ? Number of surgeons performing the operation
• Inclusion/exclusion criteria
• ? Basis of claim for decreased pain
![Page 14: Parathyroid gland surgery](https://reader035.fdocuments.us/reader035/viewer/2022062313/557e6afdd8b42a7b5c8b45be/html5/thumbnails/14.jpg)
Conclusion
• Some deficiencies in paper
• Large series
• Reports good results
• Technique worth considering