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Parathyroid Surgery

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  • 1. Parathyroid surgery George Ferzli MD, FACS SUNY Downstate Medical Center Lutheran Medical Center
  • 2.
    • Total parathyroidectomies: 132 patients
    • Sex:
      • 32 males
      • 100 females
    • Age – 28 to 88 years (mean = 59)
  • 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. SESTAMIBI SCAN
    • Hyperfunctioning parathyroid gland: 114 patients
    • Inconclusive or no uptake: 14 patients
    • Scan not done: 4 patients
  • 5.
    • OR TIME
    • 15’ – 165’ (mean = 42 minutes)
    • ANESTHESIA
    • All patients received general anesthesia
    • No intraoperative PTH assay
    • No image gridding
    • HOSPITAL STAY (mean = 1.1 day)
    • 129 patients = 1 day
    • 2 patients = 2 days
    • 9 patients = 9 days
    • (psych patients)
  • 6. LENGTH OF INCISION: 2cm - 6cm (mean = 2.28cm) 2cm - 93 patients 3cm - 37 patients 4cm - 1 patient 6cm - 1 patient
  • 7.
    • PARATHYROID GLAND
    • Frozen sections done for all patients
    • PATHOLOGIES
    • Hyperplastic 35
    • Adenoma 96
    • Cancer 1
    • WEIGHT
    • 70mg - 370mg (mean = 545.63mg)
    • SIZE OF GLAND
    • 0.9x0.6x0.3 - 3.5x2.5x1
    • LOCATION OF THE GLAND (dual adenomas in 2 patients)
    • Right upper 9
    • Right lower 37
    • Left upper 28
    • Left lower 58
    • 3 thyroidectomies done at the same time
  • 8. COMPLICATIONS
    • Hypocalcemia 1 patient
    • Vocal chord paralysis 1 patient
    • (transient RLN)
    • False positive
    • SESTAMIBI scan: 2 patients
  • 9. LENGTH OF FOLLOWUP
    • 4 - 88 months (mean = 64 months)
    • January 2000 – April 2007
  • 10. CONCLUSION
  • 11.
    • An incision is made along a
    • skin crease high up in the neck.
    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:
  • 14.
    • Middle thyroid vein
    • ligated and divided
  • 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