Abstract
Adil et al reported exemplary outcome in patients with primary hyperparathyroidism who underwent minimally invasive radioguided parathyroidectomy (MIRP). 1 This degree of success is envied by all who perform parathyroid surgery. There exist varied opinions regarding this technique, especially with respect to the role of radioguidance during the procedure. Most likely, the application of the “20% rule,” as described by Murphy and Norman, has a much greater impact than intraoperative guidance to the adenoma in the vast majority of cases. 2
In their article, the authors report the use of both MIRP and serum and rapid intraoperative parathyroid hormone assays in all patients. It is unclear from the Methods section whether termination of the procedure was based upon the results of the MIRP approach, the rapid intraoperative parathyroid hormone (PTH) assessment, or both. More importantly, given the concerns of cost containment in medicine, why did the authors feel it necessary to perform two procedures to confirm successful surgical excision, especially when a prior report documented a similar 100 percent success rate with MIRP alone? 2
In addition to the 100 percent success rate of surgery for the hyperparathyroidism, the authors report no cases of postoperative recurrent laryngeal nerve dysfunction. With a similar concern with respect to cost containment, I would appreciate the authors commenting on why recurrent laryngeal nerve monitoring was added in 2005 (year 8 of 11 in the study). Without a single recurrent laryngeal nerve injury in the first eight years of the study, what benefit would recurrent laryngeal nerve monitoring add, given that no patient prior to 2005 had a recurrent laryngeal nerve injury?
Finally, articles regarding the outcome of a focused surgical experience such as this large series have merit, even if they only confirm results of other groups. An important component of reporting such series is having all operative surgeons contribute as authors. There is little doubt that subtle nuances and insight that significantly add to the quality of publications such as this one can be provided by each contributing surgeon. It is unfortunate that one of the surgeons (with extensive experience in parathyroid surgery) who contributed cases to this series was not included as an author of the article.