Difference between revisions of "Parathyroidectomy"
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* Symptomatic hypocalcemia | * Symptomatic hypocalcemia | ||
* Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback. | * Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback. | ||
* | * Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy | ||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Revision as of 14:34, 5 May 2021
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| User likes | 0 |
Normal human physiology consists of four parathyroid glands. A parathyroidectomy is the removal of one or more of these glands or ectopic glands in patients who have primary hyperparathyroidism. Patients typically present with elevated calcium and associated symptoms of hypercalcemia. For most patients with hyperparathyroidism, only one gland is affected (single adenoma), which allow for minimally invasive parathyroidectomy. However, most procedures are still open parathyroidectomies.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | Hypercalcemia can cause altered mental status, weakness, myalgia, and rarely seizures |
| Cardiovascular | Hypertension and tachycardia are common |
| Respiratory | Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin) |
| Gastrointestinal | Hypercalcemia can cause constipation, nausea/vomiting |
| Hematologic | |
| Renal | Hypercalcemia can cause polyuria/polydipsia resulting in other electrolyte abnormalities. Also increased risk for nephrolithiasis |
| Endocrine | |
| Other |
Labs and studies
- EKG
- CBC
- BMP to evaluate calcium, magnesium, phosphate,
Operating room setup
Patient preparation and premedication
Patients should receive IV fluids and diuresis to control calcium levels.
Radioactive tracers such as methylene blue or technetium Sestamibi may be administered preoperatively to facilitate detection of parathyroid glands intraoperatively.
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Intraoperative nerve monitoring (IONM) is used by surgeon to avoid injury to recurrent laryngeal nerve
Induction and airway management
Positioning
- Supine
- Shoulder roll
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Regular calcium levels to evaluate for postoperative hypocalcemia, which can occur in up to 15% of patients.
Pain management
Potential complications
- Symptomatic hypocalcemia
- Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.
- Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang and Chris Rishel