Comparison of efficacy and safety between minimally invasive parathyroidectomy and bilateral neck exploration for primary hyperparathyroidism: A systematic review and meta-analysis.
Guang Yang, Xun Zheng, Tianfeng Xu et al.
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In 30 seconds
This systematic review and meta-analysis compared minimally invasive parathyroidectomy (MIP) with bilateral neck exploration (BNE) for primary hyperparathyroidism. Across 42 studies comprising 12,832 patients, cure rates did not differ significantly (odds ratio, 1.20; P = .35). Compared with BNE, MIP was associated with shorter operative time and hospital stay, lower medical expenses, and fewer reported complications, including temporary hypocalcemia, hematoma, and recurrent laryngeal nerve injury. The conversion rate from MIP to BNE was 8.5%. The authors advise individualising approach selection according to localization, patient factors, intraoperative parathyroid hormone use, and surgeon experience.
Key findings
- Cure rates were not significantly different between MIP and BNE (odds ratio, 1.20; P = .35).
- MIP was associated with shorter operative time (mean difference, -33.10 min; P = .0002) and hospital stays (mean difference, -0.67 days; P < .0001).
- MIP was associated with lower incidences of temporary hypocalcemia (odds ratio, 0.47; P < .00001), hematoma (odds ratio, 0.44; P = .02), and recurrent laryngeal nerve injury (odds ratio, 0.53; P = .04).
- The conversion rate from MIP to BNE was 8.5%.
Why it matters
The pooled findings suggest that MIP can achieve cure rates comparable to BNE while being associated with shorter procedures and admissions and fewer reported adverse events. These comparisons help frame the trade-offs between operative approaches, while the conversion rate and the authors’ emphasis on localization, patient factors, and surgeon experience underscore that results do not establish one approach as suitable for every patient.
What to keep in mind
The meta-analysis combines 42 studies, and the abstract does not specify their designs or report study-level heterogeneity; comparative findings should therefore be interpreted in light of the underlying evidence.