Matt is an aspiring Surgeon currently working in Palmerston North Hospital as a non-training registrar. During 2018 he worked in the General Surgical Department in Wellington Hospital along side Simon Harper and Tony Phang and will be presenting work undertaken during this period. He has undertaken his medical degree at Otago University and has subsequently completed a Post-Graduate Diploma in Surgical Anatomy in 2018.
Assessment Of The Utility Of Intraoperative Parathyroid Hormone Monitoring In Minimally Invasive Parathyroidectomies
Aim Minimally invasive parathyroidectomy (MIP) is indicated in cases of primary hyperparathyroidism where localisation studies have identified a single target parathyroid. Intraoperative parathyroid hormone (ioPTH) monitoring is used during MIP to predict cure or conversion to bilateral neck exploration (BNE) should the ioPTH levels fail to fall; in New Zealand this significantly increases operative time and cost. The aim of this study was to assess the utility of ioPTH in achieving definitive biochemical cure with a single operation in patients undergoing MIP.
Method A retrospective analysis was undertaken on all patients who had MIP with ioPTH in Wellington Regional Hospital during a 5 year period from Jan 2014 to Dec 2018. All patients were assessed for conversion to BNE and their ioPTH levels were recorded. Also anaylsed were pre-operative imaging modalities, apparent imaging concordance and definitive cure (defined by post-operative calcium and PTH levels at follow-up).
Results After exclusions, 47 patients were included for analysis with a median age of 60±12.7 and 77% female predominance. All patients had at least double imaging concordance pre-op while 6 had triple concordance. The use of ioPTH led to a total of 4 conversions to BNE (8.51%) which was appropriate in 3 instances (6.4%). ioPTH led to the inappropriate conversion to BNE in a single case (2.1%). 2 patients (4.3%) met criteria for an appropriate drop in ioPTH but were not cured by MIP. Of the 5 patients who had multi-gland disease not identified on pre-operative imaging ioPTH correctly identified 3 of these (60%).
Conclusions Overall the use of ioPTH led to additional biochemical cure in 6.4% cases. This is at the expense of extended theatre time for all patients, limitations on theatre utilisation and one unnecessary BNE. To validate the ongoing use of ioPTH a more timely assay should be available in theatre.