Our Summary

This study is a review of different techniques used to perform remote-access parathyroidectomy (RAP), a minimally invasive surgical procedure aimed at removing the parathyroid glands, which are small endocrine glands in the neck that produce parathyroid hormone. This type of surgery has evolved since it was first introduced in 2000.

The researchers looked at 71 different studies to evaluate and categorize the different RAP techniques. They found five main methods: (1) using endoscopic and robotic tools via the armpit, (2) approaching from the front of the chest, (3) entering through the mouth, (4) going in behind the ear, and (5) a blend of these methods.

The review suggests that RAP is just as safe and effective as traditional, open surgery for removing the parathyroid glands. Each method has its pros and cons, and the choice of which one to use could rely on factors like the surgeon’s comfort and experience with the technique, the patient’s preferences, and the specifics of the patient’s condition.

FAQs

  1. What are the five approaches to remote-access parathyroidectomy (RAP) according to the study?
  2. How do the cure rates and safety of RAP compare to those of open parathyroidectomy?
  3. On what factors might the selection of a RAP approach depend?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to discuss with their surgeon the different approaches available, such as endoscopic and robotic axillary, anterior chest, transoral, retroauricular, or a combination of these approaches. It is important to consider the surgeon’s experience and familiarity with each approach, as well as the patient’s preference and disease status, when selecting the most appropriate method for the procedure.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism, and those with parathyroid adenomas or hyperplasia. Patients who have not responded to medical management or who have severe symptoms such as kidney stones, bone pain, fractures, or high calcium levels may also be recommended for parathyroidectomy. Additionally, patients who are at risk for complications of hypercalcemia such as kidney damage or heart issues may also be candidates for parathyroidectomy.

Timeline

Before parathyroidectomy:

  • Patient may experience symptoms of hyperparathyroidism, such as fatigue, weakness, bone pain, kidney stones, and changes in calcium levels.
  • Patient may undergo blood tests and imaging studies to diagnose hyperparathyroidism and locate the abnormal parathyroid gland.
  • Patient may discuss treatment options with their healthcare provider, including the possibility of parathyroidectomy.

After parathyroidectomy:

  • Patient may experience relief from symptoms of hyperparathyroidism, as the abnormal parathyroid gland is removed.
  • Patient may have a follow-up appointment with their healthcare provider to monitor calcium levels and ensure proper healing after surgery.
  • Patient may need to take calcium and vitamin D supplements temporarily after surgery, as the remaining parathyroid glands may be temporarily suppressed.
  • Patient may have a scar at the incision site, which typically heals well over time.

What to Ask Your Doctor

  1. What are the different approaches to remote-access parathyroidectomy?
  2. How do the cure rates and safety of remote-access parathyroidectomy compare to traditional open parathyroidectomy?
  3. What are the advantages and disadvantages of each approach to remote-access parathyroidectomy?
  4. How will the selection of approach method be determined for my specific case?
  5. What is your experience and familiarity with the different remote-access parathyroidectomy techniques?
  6. How will my preference and disease status be taken into consideration when selecting the approach method?
  7. What are the potential risks and complications associated with remote-access parathyroidectomy?
  8. What is the expected recovery time and follow-up care after remote-access parathyroidectomy?
  9. How will my calcium and hormone levels be monitored post-surgery?
  10. Are there any alternative treatment options to consider before undergoing remote-access parathyroidectomy?

Reference

Authors: Saito Y, Ikeda Y, Takami H, Abdelhamid Ahmed AH, Nakao A, Katoh H, Ho K, Tomita M, Sato M, Tolley NS, Randolph GW. Journal: Head Neck. 2022 Aug;44(8):1976-1990. doi: 10.1002/hed.27068. Epub 2022 Apr 25. PMID: 35467046