The New York Center for Advanced Parathyroid Surgery

15 Maple Avenue | Warwick, NY 10990

Toll Free: 888-760-0966

Parathyroid Surgery
In the medical profession, there is uniform agreement
that persons diagnosed with primary
hyperparathyroidism require surgery for removal of the
abnormal parathyroid adenoma. You may not be
experiencing any of the common signs or symptoms such
as bone pain, kidney stones, or abdominal discomfort;
nevertheless, the constantly elevated parathyroid
hormone level is causing thinning of your bones and
abnormally elevated calcium. Ultimately, this leads to
osteoporosis, which may result in bone fractures in later
years of life. The "wait" strategy is no longer considered a
reasonable option for most people.

Traditional vs Minimally Invasive Surgery

The traditional parathyroid operation technique
requires a large incision in the neck to locate and
examine the four parathyroid glands located behind
the thyroid. The tumorous gland or glands are then
located and removed. Patients that opt for
traditional surgery require at least one night of
hospitalization. In the end, the patient is left with a
large inch scar on the neck.

Minimally invasive parathyroidectomy is an outpatient procedure that requires an incision of only a one-
inch or less, and the procedure can be performed in less than half an hour.

Preoperative parathyroid imaging and localization of the abnormal parathyroid tumor enables a
minimally invasive or "mini-incision" approach to the parathyroid glands. Finding the tumor before
incision allows us to make a smaller incision without the need to do a traditional neck exploration. A
2cm incision is made directly over the abnormal parathyroid gland. Because over 90% of patients with
primary hyperparathyroidism have a single parathyroid adenoma, it's usually not necessary to explore
all four glands.

The focused lateral mini-incision parathyroid surgery approach provides the most direct access to the
parathyroid glands with a minimum of tissue manipulation. A 2cm incision is made directly over the
abnormal parathyroid gland. Because over 90% of patients with primary hyperparathyroidism have a

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 The New York Center for Advanced Parathyroid Surgery
15 Maple Avenue | Warwick, NY 10990
Toll Free: 888-760-0966

single parathyroid adenoma (tumor of the parathyroid glands) it is not necessary to explore all 4 glands
in most cases. A successful preoperative parathyroid imaging localization of a single parathyroid
adenoma is necessary for us to use this approach. In addition, the patient's neck skin anatomy should
demonstrate that the lateral parathyroid surgery approach is aesthetically superior to a midline mini-
incision. Each case is judged individually. In some cases, it is decided that the best parathyroid surgery
approach is midline.

The Midline Parathyroid Surgery Approach

There are cases where we decide a mid-line incision would be more advantageous. If there are multiple
adenomas, we use this parathyroid surgery approach as we may require access to visualize both sides of
the neck. If preoperative imaging does not demonstrate the adenoma, we use this approach, as a
bilateral traditional neck exploration may be necessary. If there is concurrent thyroid disease or nodules
that need exploration or surgical intervention, then we use a midline approach.

Finally, the neck is bandaged and the patient is ready to go home. Because the operation is performed
quickly and with limited dissection, patients can usually leave the hospital the same day. Overall pain is
minimal, and the bandage is left in place for about a week.

Parathyroid Surgery Steps

The overproducing parathyroid gland is made radioactive so it can be differentiated from the other
structures in the neck. By using the Sestamibi scan, only the parathyroid tumor becomes radioactive.

Now that the surgeon knows what general area to operate upon, the surgeon makes a small incision and
only operates in a small area of the neck.

A miniature hand-held radiation probe is inserted into the incision to find the radioactive parathyroid.
Then the surgeon dissects where there is greatest probe activity in the area of the overactive
parathyroid tumor.

Once the tumor is removed, the surgeon measures the radioactivity in the parathyroid to make sure that
the entire radioactive tumor has been removed. The surgeon will then determine whether more
operating is necessary.

Finally, the neck is bandaged and the patient is ready to go home. Because the MIRP operation is
performed quickly and with limited dissection, patients can usually leave the hospital the same day.
Overall pain is minimal, and the bandage is left in place for about a week.

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 The New York Center for Advanced Parathyroid Surgery
15 Maple Avenue | Warwick, NY 10990
Toll Free: 888-760-0966

Minimally Invasive Parathyroidectomy

At the New York Center for Advanced Parathyroid Surgery, we have the benefit of placing our
operative suites next to our imaging facility enabling the ready use of the minimally invasive
parathyroidectomy technique.

About 97% of parathyroid disease patients have only one bad parathyroid. So rather than use the
traditional parathyroid operation technique requiring a large neck incision to locate and examine the
four parathyroid glands, this surgical technique simply removes the one bad gland and leaves the others
alone.

Minimally invasive parathyroid surgery is an outpatient procedure that requires just a one-inch incision
and can be performed in less than half an hour. In addition, patients recover faster with minimal
scarring.

At the New York Center for Advanced Parathyroid Surgery, we perform the latest in minimally invasive
parathyroid surgical techniques. For more information about your parathyroid surgery treatment
options, visit www.advancedparathyroid.com.

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