Changing Trends in Preoperative Localization and Surgical Techniques for the Treatment of Primary Hyperparathyroidism in a Single Tertiary Center

Purpose: Primary hyperparathyroidism (PHPT) is caused by the oversecretion of parathyroid hormone (PTH), resulting in increased serum calcium levels. The aim of this study was to analyze changing trends in preoperative localization and surgical techniques for the treatment of PHPT in a single tertiary center in Korea. Methods: Data from patients with PHPT who had undergone parathyroidectomy between January 2000 and December 2016 were evaluated in this retrospective analysis. Results: Data from 157 patients were included in this analysis (single adenoma n=156, double adenoma n=1). A total of 134 patients underwent ultrasonography for preoperative localization, 110 of which were marked preoperatively. Preoperative localization by sonographic marking increased over time following its introduction in 2006. Intraoperative PTH assay was used in 80 patients, with its use also increasing each year since it was introduced in 2011. In addition, 150 patients underwent 99mTc-sestamibi scan and 148 underwent computed tomography (CT) scanning. Four-dimensional CT and 99mTc-sestamibi SPECT/CT (SeS) was introduced in 2011 and replaced the use of 2-dimensional CT and 99mTc-sestamibi scan over time. Statistical analysis revealed that sonographic marking, SeS, CT, intraoperative PTH significantly reduce operation time. Surgical techniques used were bilateral neck exploration (n=11), unilateral neck exploration (n=54), focused parathyroidectomy (n=84), and others (n=8). Among 5 surgical technique, focused parathyroidectomy took significantly lesser operation time than other surgical methods. Conclusion: In order to reduce operation time, sonographic marking, SeS, CT, intraoperative PTH should be performed perioperatively, and focused parathyroidectomy could be the first choice of surgical methods.