Minimally Invasive Parathyroid Surgery

Minimally Invasive Parathyroid Surgery

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Duke is one of the nation’s few centers to treat primary hyperparathyroidism with minimally invasive parathyroid surgery in an outpatient setting, often under local anesthesia. Our minimally invasive approach results in less pain and faster recovery with fewer side effects when compared to conventional parathyroid surgery.

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About Parathyroidectomy

Conventional Parathyroidectomy
Surgery is the first-line treatment for primary hyperparathyroidism and has cure rates in excess of 95%. Conventional parathyroid surgery requires a large neck incision so surgeons can view all four parathyroid glands in order to identify the gland that needs to be removed.

Minimally Invasive Approach
When appropriate, our endocrine surgeons use sophisticated imaging technology before surgery, and fast biomedical testing during surgery to pinpoint the overactive parathyroid gland for removal through several one-inch incisions. The procedure is often performed under local anesthesia in an outpatient setting. You may go home the same day and experience fewer complications related to anesthesia such as vomiting, nausea and sore throat when compared to conventional parathyroidectomy. The smaller incisions minimize scarring and create a more cosmetically pleasing result.

Personalized Approach
Not every patient with parathyroid disease is a candidate for the minimally invasive approach. We have performed thousands of parathyroidectomies. We have the expertise to assess your specific condition, and recommend the best approach to meet your individual needs.

Sometimes Complex Surgery Is Necessary
In some cases, more complex surgery may be needed to surgically remove multiple overactive glands. For the very rare instance of parathyroid cancer, surgery may also include removal of lymph nodes, thyroid tissue, muscles and nerves from the neck or the affected area, depending on the extent of disease.

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Duke Health offers locations throughout the Triangle. Find one near you.


Surgical Consultation

Once a diagnosis of primary hyperparathyroidism has been secured, a surgical consultation can determine if you need surgery or can be safely monitored without surgery. If surgery is indicated, preoperative imaging of the overactive parathyroid gland(s) can indicate if you are a candidate for minimally invasive parathyroidectomy.  

Sestamibi-SPECT Scan

A mild radioactive dye (called sestamibi) is injected into the vein and absorbed by the overactive parathyroid gland. Rotating X ray scans identify the presence and location of the sestamibi. This test does require injection of the dye and multiple X rays, and can sometimes be more time consuming. 

4-D CT Scan

The “4-D” refers to the fourth dimension – which is very precise timing of the intravenous contrast and the scanning. This test is very accurate and finds parathyroid glands that may hide in uncommon areas such as high in the neck, behind the great vessels, such as the carotid, behind the esophagus, or in the chest.  This test requires expertise in performing the scan properly, and interpreting it well. It requires intravenous contrast and does have radiation exposure. 

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Why Choose Duke

Less Pain, Excellent Long-Term Cure Rates
Our patients experience fast recovery times, less pain, return to work/life quickly and have minimal chance of experiencing significant side effects such as hoarseness or low calcium levels. Research shows that patients who undergo minimally invasive parathyroid surgery experience excellent long-term cure rates which are comparable to patients who undergo traditional, more invasive parathyroid surgery. 

Sophisticated Pre-Operative Imaging
We use 4-D Computed Tomography (CT) imaging -- available at only a handful of centers in the country -- to locate hard-to-find parathyroid glands before surgery. 
For the rare occasions where parathyroid glands are located in hard-to-reach areas such as  the chest, we work closely with thoracic surgeons using minimal access techniques to remove these glands safely. 

Surgical Success Confirmed in the OR
Our surgeons use a 10-minute hormone test during surgery to confirm the success of the operation. Surgeons may also use a gamma probe to detect low-level radioactive tracers that accumulate in overactive parathyroid glands. The probe detects the tracer and confirms whether the surgeon has removed the affected area.

Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.