Minimally Invasive Parathyroid Surgery

What you should know

• Minimally invasive parathyroid (par-ah-THI-roid) surgery is surgery to remove a parathyroid gland or parathyroid tumor (lump). The parathyroid is made of four tiny glands that usually sit next to or behind the thyroid gland. Parathyroid glands make hormones (special chemicals) that control the amount of calcium in your blood. If any of the parathyroid glands become too big or overactive, you may have a condition called hyperparathyroidism. Hyperparathyroidism is when parathyroid glands make too many hormones and cause you to have too much calcium in your blood. This condition may be caused by tumors, such as adenomas or cancer, kidney disease, or a lack of vitamin D in the body. This may lead to serious health problems, such as weak bones, fractures (broken bones), kidney stones, heart problems, and depression.
  
  
• Minimally invasive parathyroid surgery is usually done when only one parathyroid gland is affected. The affected gland should be less than 3 centimeters in diameter and not be malignant (cancer). The patient should also not have any thyroid disease and previous radiation therapy of the head and neck area. During this surgery, your caregiver will make small incisions (cuts) on one side of the neck or chest and armpit (underarm). Caregivers may use special tools, a radiation hand-held probe (wand) or a laparoscope to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the neck area while watching the images on a monitor. Your caregiver may also need to do imaging and laboratory tests during and right after the surgery. With minimally invasive parathyroid surgery, your hyperparathyroidism symptoms may be treated and your quality of life improved.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• There are always risks with surgery. You may bleed more than usual or get an infection. You could have trouble breathing or get blood clots. Your thyroid gland, blood vessels, or other tissues may be damaged during surgery. You may have nerve or vocal cord damage, or have a hoarse or weak voice after your parathyroid has been removed. This may last for a few days or longer. You may have a lower than normal calcium level in your blood after surgery.
  
  
• If you do not have surgery, your overactive parathyroid glands could cause too much calcium to build up in your blood. This could cause problems, such as fatigue (tiredness), and bone, joint, or muscle pain. You may also have headaches, muscle spasms, weak bones, fractures (broken bones), hallucinations, and confusion. You could also have kidney problems, such as kidney stones and kidney function problems, or heart problems, such as congestive heart failure. You could even die if your parathyroid gets too overactive and is not treated. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

Getting Ready

The week before surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• If you are a female, tell your caregiver if you think or know that you are pregnant.
  
  
• You may need to have blood tests, an electrocardiogram (ECG), chest x-ray, and other tests. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.

The night before surgery:

• Remove any nail polish.
  
  
• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of surgery:

• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine. Your caregiver may give you an IV injection of a radioactive dye, 99mTc-sestamibi, 1 to 2 hours before your surgery. This will help him clearly see your overactive parathyroid gland during the surgery.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved onto a special bed. Caregivers may give you local, regional, or general anesthesia to numb the surgical area or put you to sleep. If you are given general anesthesia, an endotracheal tube (ET) may be put into your mouth or nose. It will help you breathe during your surgery. Caregivers will clean your neck and upper chest area with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the surgery area clean.
  
  
• During your surgery, a small incision (cut) will be made in one side of your neck. Muscles and other structures near the affected parathyroid gland are lifted and pulled aside. A hand-held probe (wand) and video may be used to show the radioactive gland and help guide your caregiver during the surgery. The parathyroid gland will then be cut out.
  
  
• Your caregivers may also make small incisions on the neck, or chest and armpit (underarm) area, to insert a laparoscope through. Caregivers may insert other instruments by making 1 to 2 smaller incisions at different places on your neck or armpit. The neck area where the parathyroid gland is will then be inflated with a gas (carbon dioxide). This will lift the skin of your neck away from the parathyroid and allow your caregiver more space to work in. Clips, cautery, loops, or special staplers may be used to separate the gland from other structures near it. Blood tests may be done during surgery to check the level of your parathyroid hormone. The incisions will be closed with stitches (threads) or surgical tapes and covered with bandages.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. If you had general anesthesia, the ET tube will be removed after you are awake and can breathe well on your own. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you may be sent home or taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your neck area. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound on or near your neck.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You have new symptoms since the last time you saw your caregiver, or your symptoms are getting worse.
  
  
• You feel too depressed or sad, or think that you cannot cope with life or your problems.