parathyroid surgery
DESCRIPTION
TRANSCRIPT
Parathyroid surgeryParathyroid surgery
George Ferzli MD, FACSGeorge Ferzli MD, FACS
SUNY Downstate SUNY Downstate Medical CenterMedical Center
Lutheran Lutheran Medical CenterMedical Center
• Total parathyroidectomies:Total parathyroidectomies: 132 patients132 patients
• Sex:Sex:– 32 males 32 males – 100 females100 females
• Age – 28 to 88 years (mean = 59)Age – 28 to 88 years (mean = 59)
Pre-op calcium = 9.1mg/dl - 13.8mg/dl (mean = 11.94mg/dl)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)Post-op calcium = 7.7mg/dl - 10.3mg/dl (mean = 9.50mg/dl)
Pre-op PTH = 37ng/ml - 452ng/ml (mean = 124.6ng/ml)Pre-op PTH = 37ng/ml - 452ng/ml (mean = 124.6ng/ml)
Post-op PTH = 16ng/ml - 119ng/ml (mean = 53.2ng/ml)Post-op PTH = 16ng/ml - 119ng/ml (mean = 53.2ng/ml)
SESTAMIBI SCANSESTAMIBI SCAN
• Hyperfunctioning parathyroid gland: 114 patientsHyperfunctioning parathyroid gland: 114 patients• Inconclusive or no uptake: 14 patientsInconclusive or no uptake: 14 patients• Scan not done: 4 patientsScan not done: 4 patients
OR TIMEOR TIME
15’ – 165’ (mean = 42 minutes)15’ – 165’ (mean = 42 minutes)
ANESTHESIAANESTHESIAAll patients received general anesthesiaAll patients received general anesthesia• No intraoperative PTH assayNo intraoperative PTH assay• No image griddingNo image gridding
HOSPITAL STAY HOSPITAL STAY (mean = 1.1 day)(mean = 1.1 day)
129 patients129 patients == 1 day1 day
2 patients2 patients == 2 days2 days
9 patients9 patients == 9 days9 days
(psych patients)(psych patients)
LENGTH OF INCISION:LENGTH OF INCISION:2cm - 6cm (mean = 2.28cm)2cm - 6cm (mean = 2.28cm)
2cm -2cm - 93 patients93 patients
3cm -3cm - 37 patients37 patients
4cm -4cm - 1 patient1 patient
6cm -6cm - 1 patient1 patient
PARATHYROID GLANDPARATHYROID GLANDFrozen sections done for all patientsFrozen sections done for all patients
PATHOLOGIESPATHOLOGIESHyperplastic Hyperplastic 3535AdenomaAdenoma 9696CancerCancer 11
WEIGHTWEIGHT 70mg - 370mg (mean = 545.63mg) 70mg - 370mg (mean = 545.63mg)
SIZE OF GLAND SIZE OF GLAND 0.9x0.6x0.3 - 3.5x2.5x1 0.9x0.6x0.3 - 3.5x2.5x1
LOCATION OF THE GLAND LOCATION OF THE GLAND (dual adenomas in 2 patients)(dual adenomas in 2 patients)Right upperRight upper 99Right lowerRight lower 3737Left upperLeft upper 2828Left lowerLeft lower 5858
3 thyroidectomies done at the same time3 thyroidectomies done at the same time
COMPLICATIONSCOMPLICATIONS
• HypocalcemiaHypocalcemia 1 patient1 patient
• Vocal chord paralysisVocal chord paralysis 1 patient 1 patient (transient RLN)(transient RLN)
• False positive False positive SESTAMIBI scan: SESTAMIBI scan: 2 patients2 patients
LENGTH OF FOLLOWUPLENGTH OF FOLLOWUP
4 - 88 months (mean = 64 months)4 - 88 months (mean = 64 months)
January 2000 – April 2007January 2000 – April 2007
CONCLUSIONCONCLUSION
An incision is made along a An incision is made along a
skin crease high up in the neck.skin crease high up in the neck.
Superior and inferior Superior and inferior subplatysmal flaps are subplatysmal flaps are developed.developed.
Rt. recurrent laryngeal nerveRt. recurrent laryngeal nerve
Tubercle of ZuckerkandlTubercle of Zuckerkandl
Rt. upper parathyroid glandRt. upper parathyroid gland
At the laryngotracheal At the laryngotracheal junction, identify the junction, identify the following structures:following structures:
Middle thyroid veinMiddle thyroid vein
ligated and dividedligated and divided
The inferior pole vessels The inferior pole vessels are dividedare divided
If total thyroidectomy, repeat If total thyroidectomy, repeat steps on left sidesteps on left side
Free trachea from thyroid by Free trachea from thyroid by dividing ligament of Berrydividing ligament of Berry
Ligament of BerryLigament of Berry