from the Experts at the Norman Parathyroid Center
Interesting stories of hyperparathyroidism we see every day. Parathyroid blog published bi-weekly.
Anesthesia for the Parathyroid Operation. We do not use an endotracheal tube on our patients. That means we don’t put a tube down into the trachea for deep general anesthesia. This patient is asleep enough so he doesn’t feel anything or move, but he is awake enough so that he breathes on his own and not by machine. The drugs used are similar to the drugs used for colonoscopy–they are given into the vein.
Tiny Incision Still Allows Examination of all Four Parathyroid Glands. We put the incision in the middle on all patients so we can get to all four parathyroid glands (see BOTH parathyroid glands on BOTH sides of the neck). The only way to assure a patient is cured, and to make sure they are cured for many years to come is to assess all four parathyroid glands. There are tricks that we have learned that make this easy through a very small incision. The man in this video is 195 pounds.
The Sestamibi Scan Was WRONG! This operation shows what happens about 4 or 5 times per day in our practice (15 parathyroid operations per day in our practice)—we operate on somebody that has ONE parathyroid tumor shown on their scan, and yet they have TWO parathyroid tumors in their neck! This is why we tell people to STOP GETTING SCANS! The scans are emphasized too much and many surgeons will tell their patients that they can have a mini-parathyroid operation because the scan is positive and the surgeon can go find the tumor. BUT, that will leave 25-30% of people with a second tumor. The scan never shows two parathyroid tumors, even though 25-30% of people have two. T The most important lesson on this video is that the scan showed one tumor, and when we operated on him we found two.
Properly Conducted, Parathyroid Surgery is Almost Bloodless. During the operation Dr Norman shows a small sponge with a few drops of blood on it. There is no trickery here… parathyroid surgery can and should be virtually bloodless.
We Look at All Four Parathyroid Glands. We look at all four parathyroid glands in about 99% of parathyroid operations we do (there are some rare exceptions). If you come to our center for a parathyroid operation, you can expect to have all four of your parathyroid glands examined to see 1) how big they are, and 2) how much hormone they are making. It is simple: the good ones stay in, the bad ones come out. Nearly 30% of patients have more than one bad parathyroid gland, so you can’t just take out the one that shows on the scan and stop the operation. And NO, measuring hormone levels in the operating room will NOT tell you if another bad parathyroid gland is present. If your doctor says he/she will measure the hormone to determine if it decreases by 50%, then know that you have a 25%-30% chance of having a second operation in the next 10 years (8% chance of needing a second operation in the next 2 months!).
We Photograph All the Parathyroid Tumors We Remove. You and all of your doctors will get a photograph of the tumor. It will have the amount of parathyroid hormone (PTH) it is producing and how much is in your blood when you go home (the first will be very high, and the second will be very low).
The Probe is Used to Measure Parathyroid Hormone (PTH). Rather than measuring the “total” amount of PTH in your blood (and taking 25-35 minutes to do so), we measure the amount that is being produced directly from each parathyroid gland. The probe measures the “activity” of any parathyroid gland. This is a 4th generation probe, a probe (and technique) that was invented (and patented) by Dr Norman in the mid 1990’s. This is MIRP parathyroid surgery. We know of no other institution world-wide that does this, but it sure makes the operation fast and safe for the patient! The probe is connected to a computer which calculates the amount of hormone being produced from each gland based upon its contained radioactivity. The operating room staff performs these tasks while the surgeon continues to operate. The amount of hormone each gland is making is recorded and becomes a part of the patient’s medical records. This also helps us understand how much calcium each patient will need in the few weeks after the operation. A lot can be learned by knowing what the other parathyroid glands are doing–another reason why we want to see and evaluate all four glands in all patients.
No Stitches to Remove. All the stitches we use to close the wound absorb in about 1.5 months. They don’t exist anymore after that. Note that the stitches used to close the skin are too small to see on the camera (smaller than a human hair). Thus there are no stitches to remove. You can shower the next day.
Return to Work and Exercise. We allow all patients to do anything they want the very next day. Most patients feel fine to return to work the next day. Some need a day or two to get over the anesthesia. We allow exercise the very next day. We put no restrictions on our patients. Do what you want!
Home in an Hour or Two. When you perform a parathyroid operation quickly and safely, the stress to the body is small, and the amount of anesthesia is small. Almost all of our patients leave the hospital between 1 and 2 hours after the operation.
To learn more, go to our page that has a lot more details.