Minimally-Invasive Radioguided Parathyroidectomy (MIRP)
Endoscopic Minimally-Invasive Video Assisted Parathyroidectomy (MIVAP)
Parathyroidectomy is an operation in which one or more parathyroid glands are removed. This operation is performed to control hyperparathyroidism (overactivity of the parathyroid glands) which is either caused by a benign tumor of one or more of the glands (parathyroid adenoma), or generalized growth and overactivity of all of the glands (parathyroid hyperplasia). In rare instances, surgery is performed on the parathyroid glands in order to remove a parathyroid cancer. Hyperparathyroidism is associated with loss of calcium from the bones (osteoporosis), elevated serum calcium (hypercalcemia), generalized weakness and fatigue, lethargy, kidney stones, stomach ulcers, joint aches and pains, and constipation.
Most surgery nowadays is safe, however, any operation has general risks including reactions to the anesthetic, chest infections, blood clots, heart and circulation problems, and wound infection. In addition there are specific risks associated with parathyroid surgery as follows:
•Post-operative bleeding may cause swelling in the throat and difficulty breathing due to pressure on the windpipe. It is usually fixed by a further operation to remove the blood clot •Injury to the laryngeal nerves may cause hoarseness of the voice. This is usually temporary, but may be permanent in up to
1 to 2% of cases. It may improve with speech therapy or further surgery to the vocal cords. If you are a singer or public speaker, any surgery to the thyroid may cause subtle long-term changes to your performing voice.
•Interference with the other parathyroid glands may cause the calcium level in the blood to drop (hypocalcemia). It is treated with calcium and vitamin D tablets and usually improves in a few weeks. •A keloid, or overgrowth of scar tissue, may form in any surgical scar. It will result in a tender, pink raised scar but may able to be treated with silicone gel tapes or steroid injections. •Even in the most expert hands, up to 5% of parathyroid tumors cannot be found at operation and the blood calcium will remain elevated (persistent hyperparathyroidism). Sometimes after successful surgery, one of the other parathyroid glands may also then become overactive and cause the blood calcium level to rise again (recurrent hyperparathyroidism).
• For a couple of days after surgery, patients who have received methylene blue to localize the parathyroids, will continue to notice a bluish green discoloration of the urine. Although methylene blue has been successfully used for more than 30 years in parathyroid surgery, there are some extremely rare side effects that could happen from the administration of this dye. These include confusion, hallucinations and abnormal limb movements that may last a few days before slowly subsiding.
• In very rare circumstances, airway obstruction may occur and a temporary emergency tracheotomy may become necessary to gain access to the airway.. This is an extremely rare life saving measure and every effort would be taken to avoid it..
I have discussed the risks, benefits and alternatives of the procedure/treatment to the patient/patient representative. I answered the patient’s/patient’s representative’s questions regarding the procedure/treatment.
I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of non-treatment, the procedures to be used, and the risks and hazards involved, and I/We have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/We understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees.
Patient / Legal Guardian:______________________________________________________________________________________