mini Sex inc Service ision (1.5-2.0 c = 0. Sex to 0.8 in) mini Sex inc Service ision (1.5-2.0 c = 0. Sex to 0.8 in) One significant problemuaffecting initial descriptions of these techniques was that many
groups
ere calling their procedures “minimall Dating y Dating invasive” without a clear definition
of what ex Dating actly the term “minimally invasive” meant. In fact, this paucity of
definitions remains a problem today, raising concern among
some experts over the possibility
that inflated claims are being used for the purpose of self-promotion (8).
The terminology problem was addressed in 2003 Service by Brunaud and associates from UC San Francisco, who systematically analyzed incision length for several types of endocrine operations. They recommended that the term “minimally invasive” only be applied to parathyroid proc tedures utilizing an incision length of less than 2.5 cm (1 in) (9).
Here at UCLA, we perform MIP using the focused lateral mini-incision technique
(see “Surgical Technique” below).
Anesthesia - Parathyroid Surgery
(See
FAQ: What type of anesthesia is used and why?)
We use a combination of local anesthesia and short-acting general anesthesia. After the patient is asleep, a breathing tube or laryngeal mask airway is placed through the mouth.
The area of the incision is then pre-treated with a local anesthetic (numbing medicine similar to what you might receive at a dentist’s office) that lasts approximately 6 hours. After surgery, our patients typically awaken with little or no pain, and many never require any pain medication after surgery. Our patients are routinely given anti-nausea medications during the operation to minimize nausea in the post-operative period.
Surgical Technique - Parathyroid Surgery
(See
FAQ: Which surgical technique is used and why?)
Dr. Yeh has had direct, hands-on experience with almost all of the MIP techniques listed above. Research studies suggest that the various techniques all offer a similarly high success rate (>98%) and low complication rate (about 1%) when performed by experienced surgeons (2). At UCLA, we favor the focused lateral mini-incision technique first described by Delbridge and associates in 2002, which involves an incision length of 1.5-2.0 cm (about ¾ in) (10). In our opinion, this method provides the most direct access to the parathyroid glands, minimizes tissue injury, and has superior cosmetic results.
We do not routinely use intraoperative radio-guidance (gamma probe) or recurrent laryngeal nerve monitoring, as neither of these adjuncts has been proven to improve the results of parathyroid surgery (11, 12). In fact, most experts agree that both are unnecessary (8, 13). (See FAQ: Is the gamma probe used during parathyroid surgery? And: Is recurrent laryngeal nerve monitoring/EMG used during surgery?) Our high success rates, which are equivalent to those published by other high-volume specialty centers, are based on experience, accurate localization studies, thorough knowledge of the anatomy and embryology, and sound surgical technique.
| View Larger Image | View Larger Image |
| The focused lateral mini-incision technique provides the most direct access to the parathyroid glands, as shown in these 3-D cutaways. |
Length of Operation - Parathyroid Surgery
Most MIP operations are completed in 30 minutes or less. The shortest operation performed here thus far lasted 7 minutes, consistent with previously published reports using this technique (14). Though we value efficiency, we do not necessarily equate fast surgery with good surgery. Patient safety is our utmost priority. Ultimately, our operations take as long as necessary to complete in a safe and meticulous manner.
| Ultrasound revealing an enlarged, oval-shaped parathyroid adenoma.Color Doppler is used to detect small blood vessels leading to the adenoma. |
We agree with recently published reports highlighting the importance of surgeon-performed ultrasound in the management of parathyroid disease (16-18).
New patients undergo ultrasound examination during their first clinic visit. Just before surgery is commenced, ultrasound is again used to position the incision directly over the diseased gland.
Intra-operative Parathyroid Hormone (IOPTH) Monitoring