Minimally Invasive Parathyroid Surgery

The parathyroid glands are small jelly-bean size glands that reside on the back surface of the thyroid gland along the recurrent laryngeal nerves with two glands on each side. They are respectively termed left inferior, left superior, right inferior or right superior. These glands are involved in maintaining the calcium balance of the body. When patients develop hyperparathyroidism this is a result of one or more glands becoming abnormally hyperactive and secreting high levels of parathyroid hormone (PTH). As a result this will result in elevated serum calcium levels. This condition over a long period of time can lead to many problems including osteoporosis, bony pain or pathologic fractures, kidney stones, abdominal problems including ulcers and even psychiatric problems such as depression.

In primary hyperparathyroidism one or more glands are overactive secreting high levels of PTH which leads to hypercalcemia. In more than 80% of cases this is due to a single enlarged parathyroid gland, termed a parathyroid adenoma, which requires removal. In a minority of cases there may be multiple adenomas or four gland hyperplasia causing the problem. A sestamibi scan is performed preoperatively to determine if one gland is the culprit.

If the scan localizes to a single gland, then a minimally invasive parathyroidectomy can be performed by your surgeon at C/V where a small 1-1.5 inch incision is made in the central lower neck and the gland is removed.  Dr. Alen Cohen is Director of the Minimally Invasive Parathyroid Surgery Program at West Hills Hospital which serves the greater Los Angeles and Thousand Oaks areas and is the first and only center in the San Fernando Valley that routinely utilizes the intraoperative PTH assay, which will tell us once and for all if we have solved the problem before surgery is over. As such you can rest assured once you leave the operating room that there is no missed adenoma and that this is the last surgery for this problem.  In this situation the calcium levels will normalize over the next few days and most patients leave within 24 hours of surgery to go home in stable condition.  However in certain situations the sestamibi scan does not localize and as such the problematic gland is not identified.

In these situations a small 2-2.5 inch incision is made in the lower central neck in a natural skin crease and a parathyroid exploration is performed to identify all four glands and only remove the problematic gland if found. If more than one gland is problematic then all which are enlarged are removed. In less than 5% of cases are all four glands problematic, termed parathyroid hyperplasia, and as such 3 and ½ glands are removed and ½ of one gland is reimplanted into one of the central neck muscles for close observation postoperatively.  Lastly, if you decide to have surgery with another surgeon please make sure they have extensive experience performing parathyroid surgery and that they utilize the intraoperative PTH assay so that you may not be subject to further unnecessary surgery in the future.

View gallery of patients post parathyroid surgery