Lahey Health is now part of Beth Israel Lahey Health

by Woods M
(Parathyroid Gland Removal—Minimally Invasive; Video-assisted Parathyroidectomy; Endoscopic Parathyroidectomy; Radio-guided Parathyroidectomy; Parathyroidectomy, Video-assisted; Parathyroidectomy, Endoscopic; Parathyroidectomy, Radio-guided)

Definition

A parathyroidectomy is a surgery to remove parathyroid glands. There are 4 parathyroid glands located in the neck. The glands make a hormone that balance the level of calcium in the blood.

Parathyroid and Thyroid Glands (Back View)
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Reasons for Procedure

The surgery is done to remove abnormal parathyroid glands. The glands can be overactive, or abnormal due to cancer or for other reasons.

This option is most often done if only 1 gland needs to be removed. This type of surgery uses smaller incisions. Recovery is often faster. If a large amount of tissue needs to be removed, an open surgery may be needed.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Possible complications may include:

  • Bleeding
  • Hoarseness
  • Low calcium levels in the blood (usually temporary)
  • Wound infection
  • Reaction to the anesthesia
  • Skin tethering—tissues and skin may become attached to the voice box or windpipe
  • Scarring
  • Blocked airway
  • Damage to nerves, which can cause problems like paralyzed vocal cords

Talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

What to Expect

Prior to Procedure

Your doctor will:

  • Do a physical exam.
  • Review previous tests such as ultrasound or blood tests.

To prepare:

  • Ask someone to drive you to and from the hospital.
  • Avoid eating or drinking 6-8 hours before surgery.
  • Talk to your doctor about any medicine, herbs or supplements that you take. You may need to stop taking some up to 1 week before the procedure.

Anesthesia

General anesthesia is used most often. You will sleep through the surgery.

Local anesthesia may be used for smaller surgeries. The area will be numb but you will be awake. You may be given other medicine to help you relax.

Description of the Procedure

There are different types of minimally invasive surgeries that may be used, such as:

Video-assisted Parathyroidectomy (Endoscopic Parathyroidectomy)

A small cut will be made in the neck. A small tube with a tiny camera will be passed through the opening. The images from the camera will be sent to a TV monitors so the doctor can see the glands. Other small tools will be passed through the tube to remove the gland. The cut will be closed with stitches or special glue.

Radio-guided Parathyroidectomy

A radioactive item will be injected into your body. The abnormal gland will soak it up, the healthy glands will not. A small cut will be made in the neck. A small probe will be inserted. The probe will read the signals from the abnormal gland. This will help the doctor find the abnormal gland. Other small tools will be passed through the tube. The gland will be removed. The cut will then be closed with stitches or special glue.

How Long Will It Take?

Between 30 minutes and 1-2 hours (depending on the type of surgery)

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. The area will be painful after surgery. Medicine will help to manage discomfort.

Average Hospital Stay

You may need to stay in the hospital for a day or you may be able to leave the same day. You may need a longer stay if there are any problems.

Post-procedure Care

At the Hospital

After your surgery, the care team will:

  • Check on your ability to swallow and speak
  • Test your calcium levels
  • Show you how to change your dressings and care for your wound

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

You will need to take it easy for a few days. Avoid strenuous activities.

You may experience a drop in calcium levels until the remaining glands adjust. A calcium supplement may be recommended until the glands recover.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

  • Tingling or numbness in the fingertips, toes, hands, or around the mouth
  • Twitching or cramping of muscles
  • Redness, warmth, drainage, or swelling around the area where surgery was done
  • Difficulty swallowing, talking, or breathing
  • Signs of infection, including fever and chills

If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery  http://www.entnet.org 

Endocrine Diseases—The American Association of Endocrine Surgeons  http://endocrinediseases.org 

CANADIAN RESOURCES

Canadian Cancer Society  http://www.cancer.ca 

Canadian Society of Otolaryngology  http://www.entcanada.org 

References

Farndon JR. Surgical treatment: Evidence-based and problem-oriented. Postoperative complications of parathyroidectomy. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967. Accessed December 28, 2018.

Parathyroid surgery. American Association of Endocrine Surgeons website. Available at: http://endocrinediseases.org/parathyroid/surgery%5Foverview.shtml. Accessed December 28, 2018.

Parathyroidectomy: minimally invasive (focused). University of California, Los Angeles Endocrine Surgery website. Available at: http://endocrinesurgery.ucla.edu/surgery%5Fmip.html. Accessed December 28, 2018.

Sadik KW, Kell M, Gorey T. Minimally invasive parathyroidectomy using surgical sonography. Int J Med Sci. 2011;8(4):283-286. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085174/.

6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

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