Reoperative Parathyroid Surgery by Ralph P. Tufano & Phillip K. Pellitteri

Author:Ralph P. Tufano & Phillip K. Pellitteri
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Localization Studies

A battery of localization studies prior to reoperation are usually employed, due to the associated risks of surgical complications and the lower likelihood of surgical cure. Approximately 90% of missed parathyroid tumors can be removed through the initial cervical incision. Successful localization permits a focused approach in most cases. This limits the amount of dissection required, preferably to a unilateral approach, as one prefers not to perform bilateral re-exploration when possible, avoiding the increased risk of hypoparathyroidism and RLN injury [12, 13]. Localization studies, in combination with previous information from operative and histologic findings, usually direct the surgeon to the abnormal parathyroid gland, thus minimizing complications and shortening the operative time. Knowledge of anatomy and expected locations of both normal and ectopic locations for parathyroid glands is paramount in reoperative parathyroidectomy, and the reader is referred to previous chapters. A variety of invasive and noninvasive techniques are available to image or localize abnormal parathyroid glands. Intraoperative PTH monitoring is a helpful adjunct for confirming when all abnormal parathyroid tissue has been removed [14–17].

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