Surgical Treatment of PHPT under Local Anesthesia

Excision of two Excision of normal parathy- parathyroid roid glands adenoma

0 10 15

Time (min after gland excision)

FIGURE 49-3. In a 45-year-old woman with primary hyperparathyroidism, two parathyroid glands were interpreted as being macroscopically enlarged and excised. Frozen section showed normal parathyroid tissue. The parathyroid hormone (PTH) level did not decrease until a 0.38-g parathyroid adenoma was removed. Data are shown as a percentage of baseline value.

Some patients with PHPT have coexisting severe cardiovascular disease and respiratory insufficiency.35 38 Surgical removal of parathyroid adenomas under local anesthesia39"41 was initially proposed as an attractive alternative to long-term medical treatment4243 or percutaneous biochemical ablation44 for high-risk patients. Focused parathyroidectomy under local or regional anesthesia has been proposed as an alternative to operation under general anesthesia for most patients with PHPT.45 48 Parathyroid exploration under local anesthesia is well tolerated by patients, and heart rate and blood pressure fluctuate less than in patients having neck exploration under general anesthesia.40

For patients who have a focused parathyroidectomy under local anesthesia, accurate localization studies are of paramount importance. If noninvasive localization studies are performed, we recommend that the results of at least two tests should agree for definite localization because of a high incidence of false-positive results 49 As an alternative, ultrasonography combined with fine-needle aspiration for PTH sampling of the suspected lesion may be used.16

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