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Parathyroidectomy-Minimally Invasive

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by Sinnott B

(Parathyroid Gland Removal—Minimally Invasive; Video-assisted Parathyroidectomy; Endoscopic Parathyroidectomy; Radio-guided Parathyroidectomy; Parathyroidectomy, Video-assisted; Parathyroidectomy, Endoscopic; Parathyroidectomy, Radio-guided)

 

What to Expect

Prior to Procedure

Your doctor will:
  • Do a physical exam and ask you about your medical history
  • Order imaging test such as ultrasound or parathyroid scan
  • Have blood tests done
You should:
  • Arrange to have someone drive you home from the hospital after surgery.
  • Avoid eating or drinking 6-8 hours before surgery.
  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets

Anesthesia

General anesthesia is used most often. It will block any pain and you will stay asleep through the surgery. In some cases, local anesthesia may be used instead. The area will be numb but you will be awake.

Description of the Procedure

There are different types of minimally invasive surgeries that may be used, such as:
Video-assisted Parathyroidectomy (Endoscopic Parathyroidectomy)
A small incision will be made in the neck. A small tube with a tiny camera will be passed through the incision. The images from the camera will be sent to a TV monitors so the doctor can see the glands. Other small tools will be passed through the tube to detach and remove the gland. Once the gland has been removed, the incision will be closed with stitches.
Radio-guided Parathyroidectomy
A radioactive substance will be injected into your body. The abnormal gland will absorb the substance but the healthy glands will not. A small incision will be made in the neck and a small probe will be inserted. The probe will detect signals that are given off by the radioactive substance in the abnormal gland. This will help the doctor find the abnormal gland. Other small tools will be passed through the tube to detach and remove the gland. Once the gland has been removed, the incision will be closed with stitches.
With either surgery, if all four glands were removed, a part of one gland may be placed in a different area of the neck or in the forearm.

How Long Will It Take?

Between 30 minutes and 1-2 hours (depending on the type of surgery)

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

You may need to stay in the hospital for a day or you may be able to leave the same day. Ask your doctor if this is an option for you. Your doctor may also choose to keep you longer if you have any problems.

Post-procedure Care

At the Hospital
After your surgery, the hospital staff will:
  • Observe you in the recovery room
  • Check on your ability to swallow and speak
  • Show you how to change your dressings and care for your wound
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
Be sure to follow your doctor’s instructions. To help your recovery at home:
  • You may be given calcium supplements.
  • You will be given instruction about caring for your wound. Check your wound daily for signs of infection.
  • You may want to eat semi-solid foods like ice cream or oatmeal for the first few days. These types of foods will be easier to swallow.
 

RESOURCES

The American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

The American Association of Endocrine Surgeons
http://www.endocrinesurgery.org

 

CANADIAN RESOURCES

Canadian Cancer Society
http://www.cancer.ca

Canadian Society of Otolaryngology
http://www.entcanada.org

 

References


Farndon JR. Postoperative complications of parathyroidectomy. In: Holzheimer RG, Mannick JA. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich, Germany: Zuckschwerdt; 2001. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967. Accessed June 18, 2013.


Parathyroid surgery. The American Association of Endocrine Surgeons website. Available at: http://www.endocrinesurgery.org/patient%5Feducation/parathyroid/surgery%5Foverview.shtml. Accessed June 18, 2013.


Parathyroidectomy. Cedars-Sinai website. Available at: http://acromegalysupport.org/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Parathyroidectomy.aspx. Accessed June 18, 2013.


Parathyroidectomy: minimally invasive (focused). University of California, Los Angeles Endocrine Surgery website. Available at: http://endocrinesurgery.ucla.edu/surgery%5Fmip.html. Accessed June 18, 2013.


6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

 

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