Parathyroid surgery requires delicate manipulations and that is why we say that parathyroid glands need demanding surgery. The surgeon should be familiar with the cervix, they do not need large incisions that are unfortunately made in some patients. On the contrary, it takes a lot of experience and the incision to be very small. The main difficulty is to locate the gland and this requires the ability, experience and specialization of the surgeon.
With more than 18 years of experience and the techniques we apply, our patient does not need to be hospitalized even for 24 hours. He speaks immediately, mobilizes and feeds after the first hours of surgery. The incision that will have after a while, will be difficult to distinguish.
How can I find an experienced parathyroid surgeon or get a second opinion?
All the recommendations of the scientific companies of the thyroid / parathyroid gland but also all the researches have proved that the possibility of a safe and successful parathyroid surgery depends on the experience of the surgeon. In general, a surgeon must perform several surgeries per year to be considered a specialist. You should not feel uncomfortable and you should ask your surgeon everything.
Ask him how many surgeries of this kind has made and what is the percentage of his personal complications. These are two of the best signs that your surgeon is experienced and safe. An experienced surgeon is waiting for you to ask and should not be offended or feel threatened by these questions. In general, you should be careful with a surgeon who makes excessive claims about his experience and success. Even when making slanderous comments about other surgeons or doctors.
The traditional technique for parathyroid surgery was bilateral neck examination. In it, the surgeon locates all four parathyroid glands and determines which glands are diseased based on their size and appearance. This technique has been proven over time to be very safe and effective when performed by an experienced surgeon. However, since 80-85% of patients with primary hyperparathyroidism have only one abnormal gland, many surgeons perform a more limited and less invasive surgery. This is done in patients who are believed to be more likely to have a single abnormal gland. This operation is known as localized parathyroidectomy. In this parathyroidectomy, the surgeon goes and removes only the abnormal gland identified in the preoperative examination.
Minimally invasive parathyroidectomy
The term “minimally invasive parathyroid surgery” is often used to refer to localized parathyroidectomy. It can really be used for any parathyroidectomy operation that is done through a very small incision. The length of the operation will vary depending on many factors, including the characteristics of the patient, etc.
There are many variations on the way a parathyroid surgery is performed based on the surgeon’s preference. When deciding on a surgeon, it is important to remember that the type of technique used is far less important than the surgeon’s personal experience and success rate.
What are the risks of parathyroid surgery?
Complications depend on the surgeon’s experience
Complications after parathyroid surgery are rare when the surgery is performed by an experienced surgeon. Research has shown that the chances of being cured without complications after surgery depend on the surgeon’s experience. In general, the risk of complications increases in patients with previous surgery (ie the patient has had previous thyroid, parathyroid or cervical surgery such as spinal surgery). The three main complications that can occur after parathyroid surgery are hoarseness, hypocalcaemia (low levels of calcium in the blood) and bleeding.
The reciprocating laryngeal nerves are located on each side of the trachea, in the area where the parathyroid glands are located. These nerves control the vocal cords. Damage to one of these nerves can cause hoarseness. The nerve can be injured while trying to remove the parathyroid gland and thus causes temporary hoarseness. In experienced hands, temporary hoarseness occurs in only 3 to 5% of cases and the voice usually recovers within a few days to a few weeks. However, in rare cases, it may take up to 6 months for the voice to fully recover. Very rarely, the nerve may be amputated or permanently injured. In experienced hands this happens in less than 1% of cases.
If hoarseness persists after six months, then the vocal cords should be addressed through a direct laryngoscopy. Speech therapy can be used to help with recovery. Fortunately, there are treatments that can improve and stabilize the voice in cases of permanent injury.
Low blood calcium levels (hypocalcaemia or hypoparathyroidism)
Low blood calcium levels can occur after parathyroidectomy because either the other parathyroid glands become dysfunctional after surgery or too much parathyroid tissue is removed.
Low levels of calcium in the blood can cause symptoms of hypocalcaemia. These include numbness or tingling in the fingertips, toes, hands and around the mouth. In more severe cases, patients may notice involuntary muscle contractions or cramps. In experienced hands, temporary hypocalcaemia occurs in up to 5% of cases. And calcium levels usually return to normal within a few days to a few weeks. However, in some cases, it may take up to 6 months for this temporary hypocalcaemia to resolve. Very rarely, a patient may have permanent hypocalcaemia. In experienced hands, this happens in less than 1% of cases.
If hypocalcaemia occurs, the patient will need calcium supplements and possibly vitamin D pills. Vitamin D helps the body absorb more calcium from the gut. Usually, symptoms should improve within 30 minutes of taking the calcium supplement.
Bleeding (i.e hematoma)
Bleeding after surgery is an extremely rare but potentially serious problem. If the hematoma increases in size, it can cause difficulty breathing. Most hematomas appear within the first 6 hours of surgery. Bleeding can occur up to a week later in patients with coagulation disorders or in those taking anticoagulants. In experienced hands, neck bleeding occurs in less than 0.5 to 1% of cases.
Inflammation of the throat after surgery is extremely rare and can occur only once in every 1,000 patients.
Do you have any question?
We know that there is a lot of information on our website and it can be difficult to assimilate it all. If you have any questions about our surgeon or the surgery you are about to undergo, contact with us and we will be happy to assist you.