Dr Amit A. | Nuances in Re-operative parathyroid surgery & Persistent hypercalcemia 1 | COMPLICON 2 скачать в хорошем качестве

Dr Amit A. | Nuances in Re-operative parathyroid surgery & Persistent hypercalcemia 1 | COMPLICON 2

Sri Shankara Cancer Hospital & Research Centre, Bengaluru hosted The International Head & Neck Oncology Conference in January 2025. Various guests from all over India and the world were invited to share their expertise and experience on different head and neck cancers. Speaker: Dr. Amit A Topic: Nuances in preoperative parathyroid surgery and persistent hyperglycemia In this video, Dr. Amit talks about: a. Careful re-evaluation of persistent hypercalcemia after initial parathyroid surgery Persistent hypercalcemia necessitates a thorough re-evaluation, including confirming biochemical diagnosis, reviewing family history for familial syndromes, and analyzing previous surgical and pathology reports to understand the potential cause of failure. b. Common causes of failure of the initial parathyroid surgery in curing hyperparathyroidism The most frequent reasons for failed initial parathyroid surgery include surgeon inexperience leading to inability to locate the adenoma in a normal location, missed multiple gland disease (like in MEN1), overlooked occult adenomas, inadequate excision of parathyroid carcinoma (though the focus is benign disease), and challenging ectopic locations. c. Identifying patients who are at higher risk for a failure initial parathyroidectomy Predictive factors for initial parathyroidectomy failure include older age (over 70), obesity, higher ASA grade, and potentially slower intraoperative PTH drop, alongside the surgeon's experience level. d. Strategies that can be implemented during the first surgery to prevent persistent disease. Preventive strategies during initial surgery involve operating only on biochemically confirmed HPT, mandating concordant localization for focused parathyroidectomy, considering advanced imaging for discordant or negative initial scans, utilizing intraoperative PTH monitoring, and ensuring complete mobilization of the thyroid gland to visualize posterior parathyroids. e. Procedure for initial parathyroid surgery vs. Procedure for re-operative paratyhroid surgery Initial parathyroid surgery typically involves either bilateral neck exploration or focused parathyroidectomy based on localization studies, while re-operative surgery requires a more meticulous approach due to scar tissue and altered anatomy, often relying on advanced imaging and careful dissection in potentially unusual locations. f. Imaging modalities for localizing the diseased gland in re-operative cases Re-operative parathyroid surgery heavily relies on repeat ultrasound, repeat high-quality sestamibi scans, MRI, and particularly 4D CT scans as the preferred imaging modality due to its combined functional and anatomical information; newer PET-CT tracers like trihexin PET-CT show promising results. g. Surgical techniques and important nuances for successful re-exploration of the neck Successful re-exploration necessitates reviewing prior surgical notes and pathology, forming a hypothesis about the cause of failure, meticulous dissection in potential ectopic locations (following embryological migration), opening the carotid sheath, and exploring retroesophageal and retropharyngeal areas, often with the understanding that missed superior glands may be inferior to inferior glands and vice versa. Watch Part 2 of this video to know more about the risks involved in initial and repeat parathyroid surgeries and how to manage them. About the Event: This talk was part of the International Head & Neck Oncology Conference held on 24th–25th January 2025 at Sri Shankara Cancer Hospital & Research Centre, a leading institute for cancer care and research in India. To stay updated on the latest cancer surgery techniques, expert lectures, and case discussions, please watch the full sessions in the playlist: Head & Neck COMPLICON 2 – Day 2    • Head & Neck COMPLICON 2 - Day 2   About Sri Shankara Cancer Hospital: Located in the heart of Bengaluru, our hospital is recognized for its patient-first approach, top-quality medical infrastructure, and a team of dedicated oncologists working to provide the best possible cancer care for all. Like, share, and subscribe for more updates from our hospital—expert talks, inspiring patient stories, surgical advancements, and healthcare events. #ReoperativeParathyroidSurgery #PersistentHypercalcemia #FailedParathyroidectomy #ParathyroidReoperation #EctopicParathyroid #Hyperparathyroidism #EndocrineSurgery #ReoperativeSurgery #iPTH #GammaProbe #Neuromonitoring #SurgicalFailure #SecondSurgery #Parathyroidectomy #CalciumDisorders