Abstract:

Objective To optimize the operative process of parathyroidectomy (PTX) for the treatment of secondary hyperparathyroidism (SHPT). Methods Four approaches including tracing/imaging, dissection, exploration, and resection were integrated into Tider process. Nano-carbon particles were used to inject into thyroid glands for imaging and separation of cervical tissue was performed with specific vision of anatomic landmarks. Parathyroid glands were thoroughly revealed by standard exploration using inspection and palpation. Resection of parathyroids should involve the surrounding tissue as more as possible. This Tider process was used into PTX for 25 patients with SHPT in Tider group since March 2018. Thirty-four patients with SHPT without use of Tider process were in control group from March 2015 to December 2018. Outcomes including operative time, operative success rate and PTH at the postoperative first day were compared between Tider group and control group. Results Total PTX and total PTX with auto-transplantation in Tider group were all done successfully in 22 cases and 3 cases, respectively. A total of 101 parathyroid were resected with maximum diameter (1.56±0.63) cm of left superior gland, (1.66±0.53) cm of left inferior gland, (1.51±0.56) cm of right superior gland, and (1.72±0.76) cm of right inferior gland. Operative time ranged from 60 to 150 min with less time [(82.8±9.5) min] in Tider group than that [(98.5±20.4) min] in control group significantly (P=0.001). No operative complications such as bleeding, recurrent laryngeal nerve injury and severe hypocalcemia were found in both groups except one case died due to suffocation after tracheal extubation in control group. PTH in Tider group was (22.9±10.3) ng/L (<65 ng/L) at the postoperative first day. However, operation failed 6 cases in control group with PTH (112.3±239.6) (7.7~1 216.0) ng/L at the postoperative first day. Operative success in control group was 82.4% with no difference in success rate between 2 groups (P=0.075). Conclusions Tider process could be useful in PTX procedure with less operative time, more standardization and successful operation.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Tider process