Parathyroid Surgery

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Parathyroid Surgery

  1. 1. Parathyroid surgery George Ferzli MD, FACS SUNY Downstate Medical Center Lutheran Medical Center
  2. 2. <ul><li>Total parathyroidectomies: 132 patients </li></ul><ul><li>Sex: </li></ul><ul><ul><li>32 males </li></ul></ul><ul><ul><li>100 females </li></ul></ul><ul><li>Age – 28 to 88 years (mean = 59) </li></ul>
  3. 3. Pre-op calcium = 9.1mg/dl - 13.8mg/dl (mean = 11.94mg/dl) Post-op calcium = 7.7mg/dl - 10.3mg/dl (mean = 9.50mg/dl) Pre-op PTH = 37ng/ml - 452ng/ml (mean = 124.6ng/ml) Post-op PTH = 16ng/ml - 119ng/ml (mean = 53.2ng/ml)
  4. 4. SESTAMIBI SCAN <ul><li>Hyperfunctioning parathyroid gland: 114 patients </li></ul><ul><li>Inconclusive or no uptake: 14 patients </li></ul><ul><li>Scan not done: 4 patients </li></ul>
  5. 5. <ul><li>OR TIME </li></ul><ul><li>15’ – 165’ (mean = 42 minutes) </li></ul><ul><li>ANESTHESIA </li></ul><ul><li>All patients received general anesthesia </li></ul><ul><li>No intraoperative PTH assay </li></ul><ul><li>No image gridding </li></ul><ul><li>HOSPITAL STAY (mean = 1.1 day) </li></ul><ul><li>129 patients = 1 day </li></ul><ul><li>2 patients = 2 days </li></ul><ul><li>9 patients = 9 days </li></ul><ul><li>(psych patients) </li></ul>
  6. 6. LENGTH OF INCISION: 2cm - 6cm (mean = 2.28cm) 2cm - 93 patients 3cm - 37 patients 4cm - 1 patient 6cm - 1 patient
  7. 7. <ul><li>PARATHYROID GLAND </li></ul><ul><li>Frozen sections done for all patients </li></ul><ul><li>PATHOLOGIES </li></ul><ul><li>Hyperplastic 35 </li></ul><ul><li>Adenoma 96 </li></ul><ul><li>Cancer 1 </li></ul><ul><li>WEIGHT </li></ul><ul><li>70mg - 370mg (mean = 545.63mg) </li></ul><ul><li>SIZE OF GLAND </li></ul><ul><li>0.9x0.6x0.3 - 3.5x2.5x1 </li></ul><ul><li>LOCATION OF THE GLAND (dual adenomas in 2 patients) </li></ul><ul><li>Right upper 9 </li></ul><ul><li>Right lower 37 </li></ul><ul><li>Left upper 28 </li></ul><ul><li>Left lower 58 </li></ul><ul><li>3 thyroidectomies done at the same time </li></ul>
  8. 8. COMPLICATIONS <ul><li>Hypocalcemia 1 patient </li></ul><ul><li>Vocal chord paralysis 1 patient </li></ul><ul><li>(transient RLN) </li></ul><ul><li>False positive </li></ul><ul><li>SESTAMIBI scan: 2 patients </li></ul>
  9. 9. LENGTH OF FOLLOWUP <ul><li>4 - 88 months (mean = 64 months) </li></ul><ul><li>January 2000 – April 2007 </li></ul>
  10. 10. CONCLUSION
  11. 11. <ul><li>An incision is made along a </li></ul><ul><li>skin crease high up in the neck. </li></ul>Superior and inferior subplatysmal flaps are developed.
  12. 13. Rt. recurrent laryngeal nerve Tubercle of Zuckerkandl Rt. upper parathyroid gland At the laryngotracheal junction, identify the following structures:
  13. 14. <ul><li>Middle thyroid vein </li></ul><ul><li>ligated and divided </li></ul>
  14. 15. The inferior pole vessels are divided If total thyroidectomy, repeat steps on left side Free trachea from thyroid by dividing ligament of Berry Ligament of Berry

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