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Parathyroidectomy—Minimally Invasive

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

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Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

A parathyroidectomy is a surgery to remove parathyroid glands. There are four parathyroid glands located in the neck. The glands make a hormone that balance the level of calcium in the blood.

Parathyroid Glands and Thyroid Glands (Back View)

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Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

The surgery is done to remove one or more abnormal parathyroid glands. The glands can be abnormal due to cancer or for other reasons.

A minimally invasive approach is usually done if only one gland needs to be removed. If more than one gland needs to be removed or if the doctor needs to do additional surgery in the neck, she may use a conventional approach instead, which involves making larger incisions.

Possible Complications

Complications are not common but, no procedure is completely free of risk. If you are planning to have a parathyroidectomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Hoarseness
  • Low calcium levels in the blood (more common if all four glands are removed)
  • Wound infection
  • Reaction to the anesthesia
  • Skin tethering—tissues and skin may become attached to the voice box or windpipe
  • Scarring
  • Blocked airway
  • Damage to nerves (which can cause problems like paralyzed vocal cords)

Factors that may increase the risk of complications include:

  • Smoking
  • Heart and lung problems
  • Prior neck surgery

Talk to your doctor about these risks before the surgery.

What to Expect

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 medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Anti-platelet drugs, such as clopidogrel (Plavix)

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.

There are different types of minimally invasive surgeries that may be used, such as:

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.

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.

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

Anesthesia prevents pain during surgery. After the surgery, you may feel like you have a cold or sore throat. Your doctor will give you medication to help manage the pain.

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.

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

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.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Tingling or numbness in the fingertips, toes, hands, or around the mouth
  • Twitching or cramping of muscles
  • Redness, warmth, drainage, or swelling around the area where surgery was done
  • Difficulty swallowing, talking, or breathing
  • Signs of infection, including fever and chills

In case of an emergency, call for medical help right away.

RESOURCES:

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)

http://www.entnet.org/

The American Association of Endocrine Surgeons

http://www.endocrinesurgery.org/

National Cancer Institute

http://www.cancer.gov/

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_education/parathyroid/surgery_overview.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_mip.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.

Last reviewed June 2013 by Kim Carmichael, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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