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MINIMALLY INVASIVE PARATHYROID SURGERY
Most operations that are done can be done with a minimally invasive approach. There are many definitions of a minimally invasive parathyroid operation. Some surgeons refer to this as one that is done with intraoperative nuclear scanning, some surgeons refer to a minimally invasive approach as one done with a small incision, others refer to minimally invasive as outpatient surgery and yet others refer to those done under local anesthesia and sedation. Our definition of a minimally invasive approach includes outpatient surgery and small incisions. Seventy-five percent of our patients go home the same day, after being observed in the hospital. It usually involves the use of local anesthetic, numbing the nerves of the superficial cervical plexus which are located behind the muscles in the neck, and using a lot of sedation so that the patient is awake but very calm and very comfortable. Patients will feel some pulling and tugging and hear some talking but a significant number of patients have no recall of the operation at all. We tend to use as small an incision as possible, located in the center of the neck in the direction of the collar. Most patients are observed for a few hours after the operation and then are sent home with calcium, either Os‑Cal 500 mg or with D four times a day or Citracal 600 mg with D four times a day. Some patients will go home on Calcitrol which is an activated form of vitamin D once or twice a day, to prevent the symptoms of low calcium.
LOW CALCIUM SYMPTOMS
The symptoms of low calcium are tingling around the mouth and fingertips. If this happens to you after the operation, you should know that it means that the operation was successful and your bones are hungry for calcium and are taking back the calcium that has been leeched out of them. In addition, you should take another calcium pill and contact our office right away. We will increase the amount of calcium you are taking orally. If the symptoms persist, some patients may need intravenous calcium. Usually, patients do quite well with large oral supplements of calcium and vitamin D after the operation.
RISKS AND COMPLICATIONS OF THE OPERATION
Some risks of the operation are those similar to any other operation. Those risks relate to heart and lung problems after general anesthesia if the operation is performed that way. The risks also are bleeding, infection and an unsightly scar. Not finding the offending gland or glands is also a known risk of the operation, as previously discussed. There are also risks related usually to other structures in the neck. These occur very, very rarely but you should, nonetheless, know they exist. There are nerves at the top of the thyroid that control the ability to hit the high notes. If these are injured during the course of the operation and if you have an excellent singing voice, it may affect your ability to hit high notes. If you do not have an excellent singing voice and this nerve is injured (the external branch of the superior laryngeal nerve), you will notice no difference in your singing or speaking voice. There is a nerve behind the thyroid, on each side, called the recurrent laryngeal nerve. This nerve controls the opening and closing of the vocal cords. If one of these nerves is injured during the course of the operation, you may have hoarseness and voice fatigue that sometimes can be lifelong. If it is injured on both sides, then the vocal cords are shut and you cannot breathe without a breathing tube placed in the trachea or windpipe permanently, called a tracheostomy. This occurs very, very rarely with parathyroid surgery. We have found that every once in a while we will have a patient who has an enlarged parathyroid gland that is very closely wrapped around the recurrent nerve. Sometimes there can be swelling over the short run with temporary nonfunctioning of this nerve. This swelling improves over time and patients get better. Permanent injury of the recurrent nerve is rare but it does occur.
WOUND CARE
Most patients are discharged with Dermabond as the primary skin closure. This is a clear glue product of Johnson & Johnson that seals the skin. You may expect that you will have some firmness under the scar and some thickening under the scar and even black and blue if local anesthetic was used. You may take a shower the next day. You do not need a Band-Aid or any bandages on the wound. If there is any drainage from the wound, please call the office as soon as possible. If you are concerned about redness in the wound, also call the office. If there are any problems with breathing, which is incredibly rare, please come directly to the hospital or the nearest emergency center. You will usually be required to have a number of postoperative visits, the first one within ten days of the operation. Please call for an appointment.
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