Single-Incision Minimally Invasive Parathyroidectomy
Board-certified otorhinolaryngologist Ron Karni, MD, was the third ENT whom Rosemary Sauceda saw after routine blood work performed by her oncologist revealed hypercalcemia. A former renal cell carcinoma patient, Sauceda was concerned that her cancer had metastasized. When her oncologist referred her to an endocrinologist, she learned she had the signs and symptoms of parathyroid adenoma.
“The endocrinologist referred me to an ENT, but I had concerns about the surgery and how he wanted to proceed, so I made an appointment with another doctor,” Sauceda says. “When that doctor told me the surgery would be difficult, I started looking for other surgeons on the Internet.”
Her search led her to Dr. Karni, an assistant professor in the Department of Otorhinolaryngology—Head and Neck Surgery at McGovern Medical School who has expertise in minimally invasive, single-incision parathyroidectomy. “Rosemary’s experience with parathyroid disease is a very common one,” he says. “Patients see their physician for routine blood work and are told they have high levels of calcium in the blood. While many conditions can cause hypercalcemia, the most common cause is the parathyroid.”
About the size of a grain of rice, the parathyroid glands are usually located on the posterior side of the thyroid. In rare cases they are located within the thyroid gland or in the chest. Normally there are four, but individuals may have as few as three or as many as six or seven, all factors that complicate localization of parathyroid tumors.
“When a patient enters my office with parathyroid disease, the challenge is always how reliably we can localize the tumor before surgery,” Dr. Karni says. “In the past, surgeons had very little data to reliably guide surgery of small parathyroid tumors. Surgery was performed through large incisions, lasted several hours and carried the risk of recurrent laryngeal nerve injury. In some cases, the tumor was not discovered. Fortunately, we now have the advantage of state-of-the-art imaging technologies specifically designed for the identification of the abnormal parathyroid, including parathyroid nuclear scans with CT fusion and 4-D CT scans.”
Sauceda also benefited from a surgeon-performed ultrasound study done immediately before surgery. “In most cases, we can identify the parathyroid adenoma on ultrasound in the operating room before surgery begins, but this requires a dedicated ultrasound evaluation with special attention to the region of interest,” Dr. Karni says. “We’ve observed that when parathyroid tumors are identified on ultrasound before surgery, the surgery is successful in nearly all cases and can be performed through a small incision in about 45 minutes. It’s like getting good intelligence before going into battle. Once we’ve located the small tumor, the surgery itself is uncomplicated because we’re removing a gland located only a centimeter or two under the skin.”
Sauceda’s parathyroidectomy was performed in September 2012. She was discharged the same day, out and about the following day and back to work within a week with her doctor’s approval.
“Dr. Karni was very thorough,” she says. “It’s important to me to understand everything that’s going to happen when I make decisions about my healthcare. I felt confident about the surgery because of his track record of success and also because of how he communicated with me. My recovery was excellent. I was tickled pink with the entire process.”
“We’re working with exciting technology,” Dr. Karni says. “We can visualize the tumor in the office and in the OR. We make a very small incision and know exactly what we’re doing. Once we remove the tumor, the patient is cured.”