Secondary hyperparathyroidism: preoperative and intraoperative topical diagnosis, surgical treatment

A comparative evaluation of topical diagnostic methods and the effectiveness of various surgical approaches was conducted in 34 patients with secondary hyperparathyroidism (SHPT). Preoperative diagnosis included radionuclide studies (RS) (scintigraphy with 99mTcsestamibi), ultrasound, CT, and MRI. Patients in Group 1 (n=10) were operated on using the Kocher approach in the neck. In patients in Group 2 (n=11), surgery was performed through a central mini-approach with bilateral revision of the parathyroid glands, using confocal laser microscopy (CLM) intraoperatively. In Group 3, the intervention was performed through a central mini-approach without ipsilateral revision. In patients with SHPT (n=34), according to the results of preoperative (ultrasound, RS, CT, MRI) and intraoperative (visually and using CLM) topical diagnosis, in 29,4% of cases (n=8) the involvement of 4 parathyroid glands is detected, simultaneous involvement of 2 glands occurs in 23,5% of cases (n=8), pathology of one parathyroid gland was detected in 47,1% (n=16) of patients. The presence of false-positive or false-negative results of using preoperative diagnostic methods from 9,1 to 63,5% of cases depending on the localization of pathological changes in the parathyroid glands and the type of instrumental method (ultrasound, RS, CT, MRI) justifies the need for additional intraoperative visualization of the glands by CLM. Parathyroidectomy from a central mini–access on the neck using CLM as a method of revision of the parathyroid glands shows advantages over the Kocher access in the treatment of SHPT due to the reduction of the time of surgical intervention from 77,5 (70,0; 120,0) minutes to 35,0 (20,0; 45,0) minutes, the exclusion or minimization of the time of stay in the emergency room and radiology department, and a reduction in the duration of the postoperative period from 13,0 (11,0; 18,0) days to 6,0 (5,0; 7,0) days.