Parathyroid gland exploration with local anesthesia in elderly and high-risk patients
L. J. Pyrtek, M. Belkin, S. Bartus and R. Schweizer
Department of Surgery, Hartford (Conn) Hospital.
The management of symptomatic hyperparathyroidism in elderly and medically
compromised patients, who are at risk under general anesthesia, may be
safely and effectively accomplished using local anesthesia. Positive
localization with ultrasound, thallium 201-technetium Tc 99m subtraction,
and computed tomography permit surgical exploration with local anesthesia
in one or two stages, or bilaterally in one stage, in selected cases, by
employing the surgical lateral approach to parathyroid surgery. Our study
of 29 patients selected for this technique affirms the value and the safety
of this method, especially as surgical experience has grown and
localization studies have improved. During the latter 24 months of our
study, 11 (30%) of 36 operations were performed using local anesthesia by
one of us. A success rate in ten of 11 cases was achieved, with one patient
requiring a second exploration for adenomatous hyperplasia while under
local anesthesia.