Nuove tecniche nella chirurgia delle paratiroidi

The diseases of parathyroid glands have assumed a growing importance for innovations in diagnosis and surgery which have enabled a more precise identification and therapy. Use of Sesta-MIBI scintigraphy allows a correct localization of the adenoma; the introduction of intraoperative monitoring of intact parathyroid hormone made possible unilateral neck exploration with a mini-incision above the adenoma. The emergence of videotechnology has led the innovation of endoscopic parathyroidectomy, realized for the first time in 1996 and subsequently performed without the use of CO2. Currently, the SPECT scintigraphy allows a three-dimensional vision of the adenoma and is the more precise localization study, allowing to use mini-invasive access. Prerequisite for the use of minimally invasive techniques is the determination of intraoperative PTH, possible with various techniques. Our experience is based on 135 patients undergoing parathyroidectomy in the last 8 years with 5 cases of persistent hyperparathyroidism submitted to reoperation, an average hospital stay of 2 days and only 6 complications (1 bleeding and 5 temporary hypoparathyroidisms). The use of new technologies in parathyroid surgery can achieve optimal results, a better cosmetic result and quicker postoperative recovery, with a low incidence of recurrence and complications.