Bilateral neck exploration under hypnosedation : A new standard of care in primary hyperparathyroidism?

• Published in: Annals of surgery 1999-03, Vol.229 (3), p.401-408
• Main Authors: MEURISSE, M, HAMOIR, E, DEFECHEREUX, T, GOLLOGLY, L, DERRY, O, POSTAL, A, JORIS, J, FAYMONVILLE, M. E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia & intensive care; Anesthesia, Local; Anesthésie & soins intensifs; Biological and medical sciences; Chirurgie; Conscious Sedation; Female; Follow-Up Studies; Human health sciences; Humans; Hyperparathyroidism - surgery; Hypnosis; Male; Medical sciences; Middle Aged; Neck; Sciences de la santé humaine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; thyroid surgery
• ISSN: 0003-4932; 1528-1140; 1528-1140
• DOI: 10.1097/00000658-199903000-00014

The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of this new approach are examined. Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses. In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) was induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach. No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was