Atlas of Parathyroid Surgery [1st ed.] 9783030407551, 9783030407568

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Alexander Shifrin Editor

Atlas of Parathyroid Surgery

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Atlas of Parathyroid Surgery

Alexander Shifrin Editor

Atlas of Parathyroid Surgery

Editor Alexander Shifrin Department of Surgery Jersey Shore University Medical Center Neptune, NJ USA

ISBN 978-3-030-40755-1    ISBN 978-3-030-40756-8 (eBook) https://doi.org/10.1007/978-3-030-40756-8 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

In memory of my father, Leonid Shifrin, the inventor of thromboelastographs, and my uncle, Vadim Shifrin, pediatric surgeon. To my mother, Margarita Shifrina, for her love and endless support. To my beloved children, Michael, Daniel, Benjamin, Julia, Christian, and Liam, who continue to provide perspective on what is truly important in life. To the love of my life, Svetlana L. Krasnova, for her love, patience, and encouragement.

Preface

The treatment of primary hyperparathyroidism involves the removal of abnormally enlarged parathyroid gland or glands with the goal of the surgery to normalize parathyroid hormone level and to achieve eucalcemia. Four-gland parathyroid exploration remains the gold standard approach for parathyroid surgery. A minimally invasive, focused, or targeted approach to remove a single parathyroid gland (an adenoma) has become a widely accepted approach for the treatment of primary hyperparathyroidism, since about 85% of patients will develop only a single parathyroid adenoma as a cause of the disease. Multiple radiological tests have been developed to localize a parathyroid adenoma and to facilitate with the minimally invasive surgical approach. Nevertheless, a classic statement by John Doppman made in 1986 remains accurate that “the only localization study indicated in a patient with untreated primary hyperparathyroidism is the localization of an experienced parathyroid surgeon.” The Atlas of Parathyroid Surgery is designed to illustrate different techniques on how to perform successful parathyroidectomy by using different approaches. Knowledge of anatomy and precise surgical technique remain the foundation of high-quality surgery. This atlas is written by renowned endocrine surgeons, experts in the field who are members of the American Association of Endocrine Surgeons and are not only involved in teaching and publishing but also have mastered this surgical technique and modernized it to the point of perfection! This  atlas  includes techniques for performing a parathyroidectomy by using traditional four-gland exploration approach and minimally invasive approaches, such as the open minimally invasive approach, video-assisted approach, backdoor approach, transoral endoscopic parathyroidectomy vestibular approach (TOEPVA), and endoscopic lateral parathyroidectomy approach. It also illustrates removal of a right and left and superior and inferior parathyroid glands. Each chapter starts with a case description that defines the main aspect of surgery. Each picture, which is taken intraoperatively, is accompanied by corresponding drawings for easier understanding of the anatomical structures and steps of the procedure. In addition, most of the authors provided a video of the same case as it is depicted in the chapter, which is annotated and can be accessed online via SpringerLink (link.springer.com). This atlas also gives some common pitfalls of the procedure in an effort to avoid complications and improve patient outcomes. We hope this atlas will provide an indispensable source of knowledge to all surgeons, those who just started their career and those who are in the more advanced stages of their practice and are learning new techniques of parathyroidectomy. Neptune, NJ, USA

Alexander Shifrin, MD, FACS, FACE, ECNU, FISS

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Acknowledgments

The creation of this atlas, covering the entire scope of parathyroid surgery, was dependent on a team effort, which was possible only with the support and enthusiasm of the many individuals who contributed to this book, my colleagues who trusted me and dedicated their time and effort to make it happen. Special thanks to Janice Pasieka, David Terris, Ralph Tufano, Marco Raffaelli, Maurizio Iacobone, Denise Carneiro-Pla, Sally Carty, James Lee, Mauricio Sierra-­ Salazar, Michael Meckel, and Haggi Mazeh, without whom this atlas would have never come to life! I am very thankful to my teachers who dedicated their lives and efforts to the science of surgery and those who made me into a surgeon and inspired me to produce this atlas: William Inabnet, MD; John Chabot, MD; Ali Bairov, MD; Steven Raper, MD; and Jerome Vernick, MD. Special thanks to my colleagues, who spent countless hours facilitating surgical procedures, collecting data, and putting the pieces of this book together, Svetlana L. Krasnova, Tara Corrigan, George Kunak, Pedro Garcia, and Gina Soler. Special thanks to the artists who worked on this atlas at Springer, to Executive Editor Richard Hruska who believed in me, and Senior Editor Lee Klein of Springer for his hard work and dedication. Finally, I would like to thank the entire staff at Springer who was very supportive from the first idea of this atlas and maintained their enthusiasm until the end.

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Contents

1 Bilateral Exploration for Hyperparathyroidism�����������������������������������������������������   1 Janice L. Pasieka and Steven Craig 2 Four-Gland Parathyroid Exploration: Subtotal Parathyroidectomy �������������������  15 Ahmad M. Eltelety and David J. Terris 3 Bilateral Neck Exploration and Subtotal Parathyroidectomy for Primary Hyperparathyroidism Due to Asymmetric Multiglandular Hyperplasia �������������  29 Maurizio Iacobone 4 Parathyroidectomy�����������������������������������������������������������������������������������������������������  35 Mariya Neymark, Haggi Mazeh, and Michal Mekel 5 Minimally Invasive Right Inferior Parathyroidectomy�������������������������������������������  45 Alexander Shifrin 6 Minimally Invasive Video-Assisted Parathyroidectomy: How to Correctly Approach the Adenoma ���������������������������������������������������������������������������������������������  55 Marco Raffaelli, Emanuela Traini, Celestino Pio Lombardi, and Rocco Bellantone 7 Minimally Invasive Left Superior Parathyroidectomy: Anterior Approach���������  69 Bernice Huang and James Lee 8 Minimally Invasive Parathyroidectomy: Targeted Left Inferior Parathyroidectomy���������������������������������������������������������������  77 Mahsa Javid and Denise Carneiro-Pla 9 Video-Assisted Left Superior Parathyroidectomy���������������������������������������������������  89 Alexander Shifrin 10 Minimally Invasive Video-Assisted Right Superior Parathyroidectomy���������������  99 Sally E. Carty and Reema Mallick 11 Minimally Invasive Parathyroidectomy: Back-Door Approach����������������������������� 109 Ahmad M. Eltelety and David J. Terris 12 Endoscopic Lateral Parathyroidectomy������������������������������������������������������������������� 115 Rafael H. Pérez-Soto, Jean-François Henry, and Mauricio Sierra 13 Transoral Endoscopic Parathyroidectomy Vestibular Approach (TOEPVA)������� 127 Rohit Ranganath, Jonathon Russell, and Ralph P. Tufano Index������������������������������������������������������������������������������������������������������������������������������������� 135

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Contributors

Rocco  Bellantone, MD UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy Denise Carneiro-Pla, MD, FACS  Division of Oncologic and Endocrine Surgery, Department of Surgery at the Medical University of South Carolina, Charleston, SC, USA Sally E. Carty, MD, FACS  Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Steven Craig, BSc, MBBS, MS, FRACS  Department of Surgery, Illawarra Shoalhaven Local Health District, NSW, Australia Ahmad  M.  Eltelety, MD Otolaryngology Department, Augusta University, Augusta, GA, USA Otolaryngology Department, Faculty of Medicine, Cairo University, Cairo, Egypt Jean-François Henry, MD  Endocrine Surgery Division, Hôpital de la Timone, Marseilles, France Bernice  Huang, MD Department of Surgery, Columbia University Medical Center, New York, NY, USA Maurizio Iacobone, MD, FEBS  Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy Mahsa Javid, MD, PhD, FRCS  Division of Oncologic and Endocrine Surgery, Department of Surgery at the Medical University of South Carolina, Charleston, SC, USA James  Lee, MD  Endocrine Surgery, Columbia University Medical Center, New York, NY, USA Celestino  Pio  Lombardi, MD UOC Chirurgia Endocrina, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy Reema  Mallick, MD Division of Endocrine Surgery, Department of Surgery, UPMC-­ Presbyterian Hospital, Pittsburgh, PA, USA Haggi  Mazeh, MD, FACS, FISA Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Michal  Mekel, MD, MHA  Department of Surgery, Rambam Health Care Campus, Haifa, Israel Mariya Neymark, MD  Department of Surgery, Rambam Health Care Campus, Haifa, Israel Janice L. Pasieka, MD, FRCSC, FACS  Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada Marco  Raffaelli, MD UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy xiii

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Rohit  Ranganath, MD Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Outpatient Center, Baltimore, MD, USA Jonathon  Russell, MD Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Outpatient Center, Baltimore, MD, USA Alexander Shifrin, MD, FACS, FACE, ECNU, FISS  Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA Mauricio  Sierra, MD, FACS Department of General Surgery, Division Endocrine and Minimally Invasive Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Rafael  H.  Pérez-Soto, MD Department of General Surgery, Division Endocrine and Minimally Invasive Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico David J. Terris, MD  Otolaryngology Department, Augusta University, Augusta, GA, USA Emanuela  Traini, PhD UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy Ralph  P.  Tufano, MD, MBA, FACS Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Outpatient Center, Baltimore, MD, USA

Contributors

1

Bilateral Exploration for Hyperparathyroidism Janice L. Pasieka and Steven Craig

Introduction A bilateral neck exploration (BNE) is a fundamental skill for any surgeon involved in the treatment of parathyroid disease, and it remains the gold standard procedure for the management of hyperparathyroidism (HPT). In experienced hands, it is a safe and highly effective procedure. Furthermore, it is a cost-effective operation that can be performed anywhere in the world, without need for sophisticated preoperative imaging modalities or intra-operative surgical adjuncts. This chapter describes the morphological information and technical steps that facilitate performing this operation in a safe and efficient manner.

• Conversion from a unilateral approach, due to failure to identify one normal and one abnormal gland • Conversion from a focused, image-directed approach, due to failure of intra-operative parathyroid hormone iPTH measurements to fall in accordance to defined criteria

Advantages of Bilateral Approach

 reoperative Considerations for Confirmed P Hyperparathyroidism

• Allows for morphological examination of all parathyroid glands to distinguish single-gland disease (SGD) from multi-gland disease (MGD), which can remain occult on preoperative localization studies and iPTH criteria • Cost-effective effective surgical strategy as it does not depend on preoperative imaging or surgical adjuncts • Lower rate of long-term recurrence compared to focused approaches [1, 2]

Indications

Disadvantages of Bilateral Approach

• Non-visualization of parathyroid adenoma on preoperative imaging studies • Discordant results on preoperative imaging studies • Limited or no access to preoperative imaging and/or surgical adjuncts such as intra-operative parathyroid hormone (iPTH) monitoring • Familial causes of HPT, including multiple endocrine neoplasia (MEN) type 1 or 2, familial isolated HPT, and HPT-jaw tumor syndrome • Four-gland parathyroid hyperplasia, including progressive secondary and tertiary HPT

• Typically requires a general anesthesia. • Exposure of all parathyroid glands and both recurrent laryngeal nerves (RLN) increases the risk of RLN injury and post-operative hypocalcemia.

J. L. Pasieka Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada S. Craig (*) Department of Surgery, Illawarra Shoalhaven Local Health District, NSW, Australia e-mail: [email protected]

Preoperative Assessment Confirmation of Diagnosis • Diagnosis of HPT is biochemical; imaging modalities aid in surgical planning only, not in diagnosis. • Initial assessment should include serum calcium, phosphate, PTH, 25-hydroxyvitamin D, 24-hour urine calcium and creatinine, serum creatinine levels. • Genetic counselling should also be considered in young patients (