الفهرس | Only 14 pages are availabe for public view |
Abstract Inroduction : More than 80% of patients with primary hyperparathyroidism have a solitary adenoma, removal of which guarantees cure. In the 1980s a unilateral approach (through a collar incision) was advocated, based on the principle that removal of the single abnormal gland in the presence of an identified ipsilateral normal gland avoided the need for the bilateral exploration. Aim of the work: To review the literature as regards different methods of diagnosis and treatment of solitary parathyroid adenoma. Review: Primary hyperparathyroidism can be defined as a state of malregulated hypersecretion of PTH by the parathyroid gland itself . While usually presenting with few symptoms, this disease is a frequent explanation for osteoporosis and nephrolithiasis. Hypersecretion of PTH with primary hyperparathyroidism may be caused by single adenoma 73-88%, multiple adenomas 1-2% generalized hyperplasia 6-17%, and parathyroid carcinoma 0.5-2%.Traditionally parathyroidectomy involves a collar incision, bilateral exploration of the neck, identification of all four parathyroid glands, and removal of the diseased gland or glands. Patients with accurately and reliably localised single gland parathyroid disease may be treated with a minimal access approach. The minimally invasive parathyroidectomy is achieved through a 2 cm skin incision placed over the appropriately localised parathyroid gland.Minimally invasive parathyroidectomy can usually be done in minutes, with a local anaesthetic cervical block and sedation or laryngeal mask airway, often as a day case procedure. Summary and Conclusion: comparing minimally invasive parathyroidectomy with a conventional neck exploration have shown reduction in operating time ,shorter hospital stay, with no notable difference in the type or number of complications. |