Name of the Procedure:

Parathyroidectomy or exploration of parathyroid(s); re-exploration

Summary

Parathyroidectomy is a surgical procedure aimed at removing one or more of the parathyroid glands. This specific type, re-exploration, involves a second operation if the primary surgery did not resolve the issue. These glands are located near the thyroid in the neck and help regulate calcium levels in the blood.

Purpose

The procedure addresses hyperparathyroidism, a condition where the parathyroid glands produce too much hormone, leading to elevated calcium levels in the blood. The goal is to normalize calcium levels and relieve symptoms such as bone pain, kidney stones, fatigue, and depression.

Indications

• Persistent or recurrent hyperparathyroidism
• High blood calcium levels unresponsive to initial surgery
• Severe symptoms affecting quality of life

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustment or discontinuation of certain medications (e.g., blood thinners)
• Preoperative blood tests, imaging studies (like ultrasound or nuclear scans), and endocrine evaluations

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the neck to access the parathyroid glands.
3. The surgeon carefully navigates through the tissues to locate and examine the parathyroid glands.
4. Diseased glands are removed or further exploration is done if the problematic gland was missed in the initial surgery.
5. The incision is closed using sutures or surgical glue.

Tools used include surgical instruments like scalpels and forceps, as well as intraoperative PTH testing to confirm removal of all hyperactive tissue.

Duration

Typically lasts 1 to 2 hours.

Setting

Performed in a hospital operating room.

Personnel

• Surgeons
• Nurses
• Anesthesiologists
• Surgical technologists

Risks and Complications

• Bleeding
• Infection
• Damage to nearby structures (e.g., thyroid gland, vocal cords)
• Low calcium levels (hypocalcemia)
• Anesthesia-related risks
• Recurrent or persistent hyperparathyroidism

Benefits

• Normalization of calcium levels
• Relief from symptoms of hyperparathyroidism
• Potential improvement in quality of life, often noticeable within days to weeks after surgery

Recovery

• Hospital stay of 1 to 2 days
• Postoperative instructions include neck care, monitoring of calcium levels, and taking prescribed calcium and vitamin D supplements
• Avoid strenuous activities for a couple of weeks
• Follow-up appointments for monitoring recovery and calcium levels

Alternatives

• Medications to manage symptoms (though less effective)
• Observation if symptoms are mild or asymptomatic
• Non-surgical interventions such as radiofrequency ablation (less common)

Pros and cons should be discussed thoroughly with your healthcare provider.

Patient Experience

• Experiences general anesthesia during the procedure
• Postoperative discomfort, manageable with pain medication
• Temporary hoarseness or sore throat
• Gradual improvement of symptoms as calcium levels stabilize