OBJECTIVE: Previous neck surgery (PNS) in patients with primary
hyperparathyroidism (PHP) is considered as a contraindication for
minimally invasive parathyroidectomy (MIP). The purpose of our study was
to determine the effectiveness of MIP in such patients. DESIGN: From
January 2003 to June 2011, 380 patients with PHP were treated in our
department; 42 had had previous neck surgery. Twenty-seven (27/42) were
selected to have MW; the remaining 15 patients had traditional neck
explorations. Selection criteria for MIP were unilateral single or two
gland disease localized preoperatively with at least two imaging
techniques and patient’s informed consent. Imaging studies included high
resolution neck ultrasound and sestamibi scan in the majority, and CT
scan, selective venous sampling and MRI in seven patients. The type of
operation done included unilateral approach under local anesthesia
(UALA) (22 cases) with one conversion to general anesthesia and
minimally invasive parathyroidectomy under general anesthesia (MIPG) (5
cases). RESULTS: Twenty-six of the 27 patients became normocalcemic
after the operation. The patient with persistent hypercalcemia underwent
successful parathyroidectomy 8 months later via mesothoracoscopy, since
the parathyroid gland was localized correctly but was beyond access via
neck. A single adenoma was found in 21 cases and hyperplasia in six.
There were no conversions to traditional exploration and no
postoperative complications. Mean duration of the procedure and length
of stay were similar to MIP in patients without PNS. Mean follow-up of
40 months (4-89 months) did not reveal any recurrence. CONCLUSION: These
results illustrate that MIP is a valuable option in selected patients
with PHP and PNS associated with no morbidity (0%), high biochemical
cure rate (96.3% in this series) and rapid recovery, while it also
substantially lowers the cost of the procedure. Preoperative
localization with two or more agreeing imaging techniques eliminates the
need for intraoperative sestamibi or qPTH test
