PARATHYROIDECTOMY

Summary

The parathyroid glands are four small pea-sized glands that sit on either side of the trachea in the neck, behind the thyroid. The parathyroid glands control the blood calcium levels by making parathyroid hormone (PTH) in response to low blood calcium levels. Since every cell in the body uses calcium to control its basic functions and communications, it is critical that calcium levels are tightly controlled. To regulate calcium within the body, PTH increases calcium levels by breaking down bones and taking their calcium, increasing calcium absorption from food in the intestines, and decreasing the amount of calcium lost by the kidneys in the urine.

When too much PTH is made by the parathyroid glands, the increase of calcium levels in the blood and excess of calcium levels in the urine can cause poor bone density, kidney stones, depression, muscle weakness and fatigue. This is known as hyperparathyroidism. When non-surgical methods fail to treat this condition, surgery is advised to remove one or more of the parathyroid glands. A parathyroidectomy is also done to remove a parathyroid tumour.

As a surgeon, Dr Kavin opts for the safest option for his patients and thus prefers the minimally invasive parathyroidectomy using laparoscopic techniques, but if needed, this surgery may be done using traditional open surgery.

Reasons for parathyroidectomy

  • As treatment for hyperparathyroidism (overactive parathyroid glands) when  calcium levels are elevated
  • To remove a non-cancerous tumour on the parathyroid (an adenoma)

Types

1Focused parathyroidectomy
Sometimes these glands are elsewhere. About 10% of the time, the parathyroid glands may not be in their typical locations and sit in what is known as "ectopic" locations. These ectopic parathyroid glands may be difficult to find, and parathyroid surgery requires a surgeon with expertise in finding ectopic parathyroid glands.

In this technique, the surgeon identifies the location of the diseased parathyroid gland(s) with localization studies before the operation. This is done by administering a small amount of radioactive tracer before this surgery and using a special ultrasound known as a handheld Geiger to locate the overactive, enlarged gland. Thereafter, under general anaesthesia, your surgeon will make a small incision in the neck. The thin tube-like laparoscope is then inserted into the incision to view the gland. This is known as a video-assisted parathyroidectomy. Another surgical instrument is then inserted to remove the diseased gland or glands directly. Sometimes a part of the gland can be moved to another place, usually the neck or arm, to preserve the function of the gland.

To make sure the correct glands were removed, your surgeon may check your PTH levels with a blood test. If they return to normal after removing the suspected parathyroid gland or tumour, treatment was successful.
2Bilateral neck exploration
While most parathyroid surgery is done as a focused parathyroidectomy, each approach has advantages and disadvantages. Both are effective when done by a surgeon highly experienced with each approach.

When taking a bilateral neck exploration, the surgeon explores both sides of the neck to look at all four parathyroid glands. The surgeon then decides which parathyroid gland(s) to remove based on the size, colour, and texture of the parathyroids.

For this technique again, the diseased parathyroid gland(s) can be identified with the help of a radioactive tracer and a handheld Geiger. However, for the vast majority of cases, these techniques are not necessary. During the operation, the surgeon will usually confirm that all of the diseased parathyroid tissue has been removed by checking the intraoperative PTH levels.

Recovery:

In most cases, you can go home after spending one night in the hospital for observation – especially if a minimally invasive approach was taken. You can expect some pain after surgery and your neck should be swollen and bruised. A drain may also be placed into the incision in your neck to drain any excess fluid. This drain will stay in place for the next two days. Soft foods should be eaten in the first few days of surgery, and the wound should be kept dry for the first week to prevent infection. It should take about 1-3 weeks to recover. Patients can usually go back to work or school in a week of surgery but may need to avoid strenuous activities and using their mouth excessively.

Your blood calcium levels should be monitored closely after surgery. Extremely low blood calcium levels may cause numbness and a ‘pins and needles' sensation in the lips, arms, or feet, and twitching of the muscles. If these symptoms are experienced, you should contact your physician. It is not uncommon to have low blood calcium levels, but oral calcium supplements may be able to relieve this. Contact your physician if you notice any symptoms of infection. Sometimes a second surgery is needed to remove more parathyroid glands.

Risks:

  • Side-effects of anaesthesia
  • Bleeding or hematoma
  • Prolonged pain
  • Infection
  • Injury of the nerves and vocal cords
  • Injury to the thyroid gland or the need to remove part of the thyroid gland
  • Hypoparathyroidism - as a result of the removal of the gland, low calcium levels may be caused
  • Difficulty breathing

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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