I am currently the only surgeon in Wales to offer both minimally invasive and conventional parathyroidectomy.
Minimally Invasive Parathyroid Surgery (MIP)
- Around 60 to 70% of patients with primary hyperparathyroidism are suitable for the minimally invasive parathyroid operation
- Suitability depends upon the results of pre-operative scans to look for the affected parathyroid gland.
- The MIP operation involves a 2cm/¾” incision on the neck and can be performed under local anaesthetic or a short general anaesthetic.
- More than 95% of patients will be cured following this procedure
- Occasionally the gland is difficult to locate and conversion of the mini incision to a conventional operation is necessary in order to find it.
Conventional Open Parathyroidectomy
- Necessary in those with negative pre-op scans
- Still an excellent procedure in terms of results
- Requires a longer, more painful incision (6-8cm)
- Is associated with slightly more pain post-operatively and a higher incidence of temporary low blood calcium in the post-op period.
- The chances of success are the same as for those undergoing MIP
Parathyroid surgery is very safe and only occasionally is it associated with problems or complications.
Scar: Parathyroid surgery is undertaken through a scar that follows the natural creases in the neck. Usually it heals well leaving only a thin line but in some people the healing leaves a scar which is more coloured and thicker than the normal scar.
Voice change: As with thyroid surgery, the small nerves to the voice box (recurrent laryngeal nerves) pass next to the parathyroid glands and may be damaged even in the most expert hands. Nerve injury leads to a husky voice but it will normally improve with time. The chance of having a permanently abnormal voice is about 1 in 200.
Low blood calcium: From being too high before the operation, the blood calcium level may fall below normal after the operation, resulting in a sensation of pins and needles in the hands and feet and occasionally muscle spasms. This is because the other 3 glands often become underactive. Their function usually recovers rapidly but you may require calcium tablets temporarily after the operation. These will be prescribed routinely with instructions on how many to take and how often.
Other complications: Certain complications may occur after any operation – particularly bleeding within the wound, infection or problems relating to the anaesthetic. Fortunately these are rare in parathyroid surgery.
Recovery: This is usually rapid, particularly following MIP. Most patients are back to normal activity by 1-2 weeks and the majority feel much better in terms of their symptoms.
Results of Surgery: Parathyroid surgery is most commonly performed to improve symptoms which may be attributable to a raised blood calcium. In general these will improve in the majority of patients. Some patients will require surgery to prevent thinning of the bones (osteoporosis) or recurrence of kidney stones. In 3-4% of patients, it is not possible to find the overactive gland at operation – further surgery may be possible but will depend upon the severity of symptoms and the level of the blood calcium.