Minimally invasive parathyroid surgery  

Minimally invasive parathyroid surgery is the removal of one or several parathyroid adenomas through a small mid neck incision. The incision is placed in the natural skin crease.  Minimally invasive parathyroid surgery includes video-assisted or endoscopic parathyroidectomy, when surgeon uses camera to magnify the view. This technique makes the healing process faster and with minimum scar formation. In order to do minimally invasive approach we utilize intra-operative parathyroid hormone (PTH) monitoring to determine the cure after the removal of parathyroid adenoma.  About 85 % of the patients with primary hyperparathyroidism will have just one parathyroid adenoma.

Scar 2 weeks after video-assisted parathyroidectomy:

SURGERY:

Anesthesia  

The procedure is done either under general or local/regional anesthesia with general sedation. The later one helps surgeon to use voice monitoring and avoid injury to important nerves which go to your vocal cords

Length of hospital stay

Surgery is performed as an outpatient procedure. The average stay after the surgery is about 3 hours. Most patients do not require overnight stay.

Pain

Most patients have little or no pain. The neck block last for about 8 hours. Some patients may feel discomfort or pressure after the surgery. It normally resolves within couple of days. Some patients might feel shoulder/arm weakness after the neck block, which also resolves within 4-8 hours after the surgery.

Postoperatively most of the patients have no pain at all. If you do develop mild pain at home, you can take either Tylenol or Motrin.

Drain: there will be no drains.

Stitches and Scars:

The stitches will be removed the day of the surgery, right before you go home. You will have just a strip of skin glue on the skin. It will peel off on its own in 6-8 days. Because the incision will be small and the stitch will be removed the same day of the procedure the size of the scar will be much less than that with traditional parathyroid surgeries performed in the past. The incision will be placed in the natural skin crease of your neck, which will help to make it less noticeable or not visible at all.

However the scaring tendency is dependent on the individual skin healing proprieties. The surgeon will make all efforts to have best cosmetic result possible.

COMPLICATIONS:

Voice changes:

Only 0.5% (1 in 200) patients experience complications related to the damage of the nerve that goes to the vocal cords. When this occurs the patient will have hoarse voice or inability to make high-pitched sounds. In about 1 in 50 operations patient might experience temporally voice changes which resolve in 8 to 12 weeks.

Low calcium level:

Bleeding:

With current technique the incidence of bleeding is close to zero.

Wound infection:

With current technique the incidence of wound infection is close to zero. You do not need any antibiotics for the surgery, unless you have condition which requires you to take antibiotics with every procedure.

POSTOPERATIVE CARE: 

Incision site:

The skin glue will peel off on its own in about 6-8 days. After that you can apply Mederma or lotion with Votamine E 3-6 times a day to the wound. Try not to have sun exposure to the wound for about 1-2 months (especially during summer months), such as it will cause skin discoloration in the wound area and it will look different from the other skin areas.

Physical restrictions:

Shower:

You can take shower next day. Do not scratch or peel off the skin glue, just wipe it with the towel.

Pathology report:

Usually available within 5-7 days after the surgery

Problem calls:

Please immediately call doctor if you develop significant neck swelling or shortness of breath shortly after surgery, or you develop cramps in your hands or legs after the surgery.

Postoperative visit:

2-3 weeks after the surgery: for wound check , pathology report, and PTH and calcium check