Minimally Invasive Parathyroid Surgery and Local Anaesthesia

At Fort Lauderdale Endocrine Surgery, we are often asked if minimally invasive parathyroid surgery can be performed without the use of inhalational agents (general anaesthetic agents) and endotracheal tubes for breathing. The answer is a qualified "yes" depending on several factors.

First, the enlarged parathyroid(s) must be localizable by high resolution ultrasonography and visible relatively close to the skin surface. In shallow necks, local injection of anaesthetic agents (like lidocaine or Marcaine) can control intra-operative pain very nicely when given in combination with an intravenous twilight sleep agent (like propofol, also known as Diprivan). In addition, oral opiates should be given pre-operatively, so that the doctor has a "headstart" on controlling post-operative pain when the patient abruptly awakens as the propofol is discontinued. In general, the parathyroid glands most amenable to this kind of Minimal Anaesthesia Care (MAC) are lower pole glands in patients with thin necks. Lower pole glands are often found just below the thyroid gland and right under the skin surface in such patients, and can be removed with 15-30 minutes of gentle surgical manipulation. Occasionally, upper glands in thin necks can be removed just as easily.

Second, the patient needs to have a good airway prior to considering anaesthesia without a breathing tube (endotracheal tube). If there has been damage to the trachea from surgery, radiation or previous intubation, it is wiser to insert a breathing tube under controlled conditions before the surgery, rather than risking an emergent intubation during surgery should the patient's breathing pattern deterioriate.

Finally, MAC with local anaesthesia cannot be used if the patient is allergic to "caines" or propofol. Because propofol produces only twilight sleep, some patients have vague dream-like recollections of their surgical experience. Occasional patients dread the idea of any memory of the surgical experience and may prefer general anesthesia for this reason.

Our experience with Minimally Invasive Radioguided Parathyroid Surgery (MIRP) under MAC anesthesia has been very favorable. Appropriately selected patients avoid the potential trauma of a breathing tube (endotracheal tube) insertion and the post-operative headache and nausea that plague up to 30% of patients who elect to have general anaesthesia. Time spent in the recovery room is shorter with this technique and overall hospital time is minimized. For more information on MAC anaesthesia with MIRP, please don't hesitate to contact us at 954-267-8883.