What are the Different Types of Parathyroid Surgery?

Patients who require parathyroid surgery to remove a portion of one or more of their parathyroid glands have several options. The traditional surgical option, which has been in use since 1925, is called a parathyroidectomy; it involves the surgeon opening incisions in the neck, evaluating which gland or glands are malfunctioning, and removing the necessary tissue. A newer technique, minimally invasive radioguided parathyroidectomy, or MIRP, involves location of the tissue that needs to be removed prior to incision. Finally, some patients may be able to have an endoscopic parathyroidectomy which is also a less invasive technique than traditional surgery and can minimize scarring.

The type of parathyroid surgery that has been in use the longest is a standard parathyroidectomy. This procedure requires the surgeon to open incisions on both sides of the neck, typically around 5 to 10 inches (12 to 25 cm) long, which exposes the four parathyroid glands. He or she then determines which gland, or in some cases glands, is enlarged and therefore malfunctioning, and removes it. The patient is placed under general anesthesia for this procedure, and typically will spend a night in the hospital. Though it has a fairly high success rate, the procedure's success is very dependent on having an experienced surgeon; it also has the disadvantage of leaving fairly large scars.

Another option in parathyroid surgery is the minimally invasive radioguided parathyroidectomy. MIRP involves using a small dose of a radioactive drug to pinpoint the abnormal parathyroid tissue, which can then be located using a special probe. The surgeon, who then knows specifically which gland needs to be removed, will open a small incision on the side of the neck where the gland lies and remove it. This procedure is generally even more successful than the traditional operation and causes fewer complications. It can also be done using local anesthesia, has a shorter, less painful recovery time, and requires a much smaller incision of roughly an inch (2.5 cm).

Endoscopic parathyroidectomy is another possible option for patients who need parathyroid surgery. An incision is made into which an endoscope is inserted which contains lighting and a camera to find the offending gland. Special instruments are then inserted to remove the damaged tissue. This operation is also less invasive than the standard procedure, leaving a very small scar in a less obvious location than on the neck, and the recovery time is also shorter and less painful.