(Parathyroid Gland Removal—Minimally Invasive; Video-assisted Parathyroidectomy; Endoscopic Parathyroidectomy; Radio-guided Parathyroidectomy; Parathyroidectomy, Video-assisted; Parathyroidectomy, Endoscopic; Parathyroidectomy, Radio-guided)
A parathyroidectomy is a surgery to remove parathyroid glands. There are 4 parathyroid glands located in the neck. The glands make a hormone that balance the level of calcium in the blood.
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Reasons for Procedure ^
The surgery is done to remove 1 or more abnormal parathyroid glands. The glands can be overactive, or abnormal due to cancer or for other reasons.
A minimally invasive approach is usually done if only 1 gland needs to be removed. If more than 1 gland needs to be removed or if the doctor needs to do additional surgery in the neck, a conventional approach may used instead, which involves making larger incisions.
Possible Complications ^
Problems from the procedure are rare, but all procedures have some risk. Complications may include:
- Low calcium levels in the blood (more common if all 4 glands are removed)
- Wound infection
- Reaction to the anesthesia
- Skin tethering—tissues and skin may become attached to the voice box or windpipe
- Blocked airway
- Damage to nerves, which can cause problems like paralyzed vocal cords
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
What to Expect ^
Prior to Procedure
Your doctor will:
- Do a physical exam and ask you about your medical history
- Order imaging test such as ultrasound or parathyroid scan
- Have blood tests done
- Arrange to have someone drive you home from the hospital after surgery.
- Avoid eating or drinking 6-8 hours before surgery.
- Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to 1 week before the procedure.
General anesthesia is used most often. It will block any pain and you will stay asleep through the surgery. In some cases, local anesthesia and sedation may be used instead. The area will be numb but you will be awake.
Description of the Procedure
There are different types of minimally invasive surgeries that may be used, such as:
Video-assisted Parathyroidectomy (Endoscopic Parathyroidectomy)
A small incision will be made in the neck. A small tube with a tiny camera will be passed through the incision. The images from the camera will be sent to a TV monitors so the doctor can see the glands. Other small tools will be passed through the tube to detach and remove the gland. Once the gland has been removed, the incision will be closed with stitches.
A radioactive substance will be injected into your body. The abnormal gland will absorb the substance but the healthy glands will not. A small incision will be made in the neck and a small probe will be inserted. The probe will detect signals that are given off by the radioactive substance in the abnormal gland. This will help the doctor find the abnormal gland. Other small tools will be passed through the tube to detach and remove the gland. Once the gland has been removed, the incision will be closed with stitches.
With either surgery, if all 4 glands were removed, a part of one gland may be placed in a different area of the neck or in the forearm.
How Long Will It Take?
Between 30 minutes and 1-2 hours (depending on the type of surgery)
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
You may need to stay in the hospital for a day or you may be able to leave the same day. Ask your doctor if this is an option for you. Your doctor may also choose to keep you longer if you have any problems.
At the Hospital
After your surgery, the hospital staff will:
- Observe you in the recovery room
- Check on your ability to swallow and speak
- Test your calcium levels
- Show you how to change your dressings and care for your wound
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
To help your recovery at home:
- You may be given calcium supplements.
- Follow your doctor's instructions.
Call Your Doctor ^
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Tingling or numbness in the fingertips, toes, hands, or around the mouth
- Twitching or cramping of muscles
- Redness, warmth, drainage, or swelling around the area where surgery was done
- Difficulty swallowing, talking, or breathing
- Signs of infection, including fever and chills
If you think you have an emergency, call for medical help right away.
American Academy of Otolaryngology—Head and Neck Surgery
Endocrine Diseases—The American Association of Endocrine Surgeons
Canadian Cancer Society
Canadian Society of Otolaryngology
Farndon JR. Surgical treatment: Evidence-based and problem-oriented. Postoperative complications of parathyroidectomy. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967. Accessed May 11, 2016.
Parathyroid surgery. The American Association of Endocrine Surgeons website. Available at: http://endocrinediseases.org/parathyroid/surgery_overview.shtml. Accessed May 11, 2016.
Parathyroidectomy. Cedars-Sinai website. Available at: http://cedars-sinai.edu/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Parathyroidectomy.aspx. Accessed May 11, 2016.
Parathyroidectomy: minimally invasive (focused). University of California, Los Angeles Endocrine Surgery website. Available at: http://endocrinesurgery.ucla.edu/surgery_mip.html. Accessed May 11, 2016.
6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed June 2016 by Michael Woods, MD