Parathyroid Surgery | Neurology
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    Parathyroid Surgery
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    Parathyroid surgery or a Parathyroidectomy, is a procedure during which the doctor removes part or all of your parathyroid glands.  It is usually done under Parathyroid surgerygeneral anesthetic and involves looking at all 4 parathyroids which are located on the outside borders of the thyroid gland in the front of the neck.

    The parathyroid glands help control the levels of calcium and phosphorous in the blood. When over-activity of the parathyroid glands happens, it is called hyperparathyroidism. This causes increased levels of calcium in the blood. You might experience muscle weakness, premature thinning of the bones, kidney stones, decreased alertness, frequent urination and occasional joint discomfort.

    BRIEF ABOUT THE PROCEDURE

    ProcedureParathyroid surgery

    In most cases, you will receive a general anesthetic. A general anesthetic will prevent you from feeling pain during the operation.

    The surgeon will make a cosmetically placed incision in your neck and expose the four parathyroid glands. He or she will remove all or part of your parathyroid glands depending on your condition. The incision is closed with sutures beneath the skin.

    You are usually in the hospital overnight and might go home the next day. You might have some swelling in your neck with local discomfort. Depending upon your calcium level, you might need to take additional calcium to avoid the symptoms of low calcium (occasional numbness and tingling in the extremities).

    Video Assisted Minimally Invasive Parathyroidectomy.

    This uses a small 2.5cm central neck incision and is very similar to our own open technique. It was first described by the Italian surgeon Professor Miccoli. To aid the surgery a 5mm 30 degree telescope is used. The surgery is gasless and performed while observing progress on a television monitor. I have many times used this method. If the gland is well localized it has little advantage over our own technique except that it allows visualization of all 4 parathyroid glands through the 2.5cm incision. The method has quite a sharp learning curve and its complication rate is be higher than our own open method.

    There is one area where I think this method should be considered: when the parathyroid tumor is in the upper chest and considered impossible to remove by the traditional or our own open method.In these circumstances removal of the tumour can be performed using the video assisted technique without the need to split the breast bone (sternum).

    Endoscopic Parathyroidectomy

    This method uses an endoscope for a bilateral exploration and needs at least 5 small incisions in the neck. It has never been popular in the UK or the USA, but has its support mainly in France. The equipment is expensive and it use is limited to small parathyroid tumors less than 3 cms in diameter. Because gas has to be infused into the neck there is a risk that gas can be trapped in the tissues which is extremely uncomfortable, although not dangerous.

    The view at surgery is excellent however, and it is a very good method if the surgeon has mastered the very steep learning curve, but the conversion rate to open operation is in the region of 13%. Advantages of this procedure are that one will no longer have high calcium levels in your blood. The abnormal parathyroid gland(s) have been removed.

    By eliminating the high calcium level in your blood, you will be protected from the short- and long-term consequences of calcium elevation.

    SOME ASSOCIATED RISKS

    With parathyroid surgery, the risks are minimal but might include:

    • Blood loss
    • Infection

    In addition, an occasional patient might have transient hoarseness, which is rarely permanent. Rarely, a patient might have recurrence of hyperparathyroidism as disease develops in a previously unaffected gland.

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    DESTINATIONS FOR PARATHYROID SURGERY

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