Surgery

PICK YOUR SURGEON CAREFULLY

The only way to cure primary hyperparathyroid disease is to surgically remove the non-cancerous adenoma(s).

Endocrine surgeons are not created equal.

  • Some surgeons only remove the parathyroid gland with the adenoma that is seen on imaging studies, such as Sestamibi scans or ultrasound scans, and do not look for other bad glands. It is our understanding that in approximately 30% of cases there will be a second bad gland, so if all 4 are not checked, a second surgery may be necessary.
  • Inexperienced surgeons may do exploratory surgery for several hours in the hope they can find the bad glands, as they are very difficult to locate. As a result, excessive scar tissue forms, making it far more difficult and sometimes impossible for a patient to have a successful second surgery if this becomes necessary.
  • Inexperienced surgeons may unintentionally remove healthy glands rather than the adenoma.
  • Others intentionally and routinely remove 3 1/2 glands and implant 1/2 in the neck or arm muscle, often causing the patient to become HYPOthyroid – a devastating condition.
  • Seeding can occur if the adenoma breaks apart during removal. These cells then continue to grow, and repeatedly need to be removed. In these cases the patient’s condition can only be managed then, they cannot be cured.

bandaid.perry.7.15

Therefore,  it is extremely important to find an expert surgeon that has performed hundreds of parathyroidectomies. Ideally, they should know how to locate and assess the 4 glands in under an hour. Some surgeons, like the ones at the Norman Parathyroid Center in Tampa, FL, will do a complete surgery, checking all for 4 glands, in less than 30 minutes on average. Ours were all 21 minutes or less. Learn more and watch a 13 minute surgery where all 4 glands are checked here .

Screen Shot 2016-04-10 at 1.49.11 AM

FINDING THE RIGHT SURGEON

UCLA Endocrine Surgery shares the following on their website,

Within the endocrine surgery community, a surgeon who performs 50 or more parathyroid operations per year is considered an expert parathyroid surgeon. These surgeons can be found through the American Association of Endocrine Surgeons (AAES). In order to become an AAES member, a fully-trained surgeon must first become a fellow of the American College of Surgeons, then submit a case log of thyroid, parathyroid, and adrenal operations (thereby demonstrating high volume and dedication to the field of endocrine surgery) to a council, and then commit to attending regular scientific conferences in order to keep current with the latest research and techniques in endocrine surgery.

For several years, we at UCLA have fielded phone calls and emails from across the country and throughout the globe from patients looking for expert endocrine surgeons. Our practice has been to refer the great majority of these patients to our trusted colleagues within the AAES and its sister organization the International Association of Endocrine Surgeons (IAES). Finally, the number of patient requests became so great that we collaborated with the AAES to create the AAES Surgeon Finder, a web page that allows you to type in your zip code and find AAES members close to your home.

The AAES Patient Education Site is visited by thousands of users each day. Each week, thousands of prospective patients browse individual surgeon profiles within the AAES Surgeon Finder to learn about and make contact with expert endocrine and parathyroid surgeons.

BECOME EDUCATED

As surgical methods vary greatly depending upon the experience and/or predilection of the surgeon, it is imperative, to do your own research and ask him or her lots of questions.  We developed the questions below to help you start the process of developing your own list of questions for your surgeon.

CONSIDERATIONS WHEN SELECTING A SURGEON 

Experience Matters!

  • Does the surgeon specialize in parathryoidectomies?
  • How many years has the surgeon been performing parathyroidectomies?
  • How many does the surgeon perform daily/weekly/monthly?
  • How many parathyroidectomies has the surgeon performed to date?
  • Does the surgeon do a pre-operative sestamibi scan? What happens if the scan is negative? Will the surgeon still do the surgery?

Surgical Methods Matter! 

  • What is the typical length for the surgery? The time required can vary greatly from surgeon to surgeon. Are we talking minutes or hours?
  • What type of anesthesia is required for the surgical procedure?
  • What method does the surgeon use to locate the tumor(s)?
  • Does the surgeon perform  minimally invasive parathyroid surgery (MIP) ?
  • Does the surgeon perform minimally invasive radio guided surgery (MIRP) ?
  • Is the surgery done on an out-patient basis or is an overnight stay required ?

Success Matters! 

  • There is always a possibility that there is more than one tumor. Does the surgeon check all 4 parathyroid glands during the surgery?
  • Will PTH levels be monitored during surgery to help ensure all adenomas have been found? How long does each of the measurements take?   
  • What other methods, if any do they use to help ensure success?
  • What is the surgeon’s success rate?
  • What complications may possibly arise?

Follow-Up Matters!

  • Will the surgeon be available for follow-up questions/appointments?
  • What will their role be if complications develop following surgery?
  • What is your surgeons recommendations for Calcium and Vitamin D  supplementation post surgery?