Minimally invasive video-assisted parathyroidectomy is a safe procedure to treat primary hyperparathyroidism.

INTRODUCTION: Cervical exploration to identify the four parathyroid glands was considered to be the gold standard for management of primary hyperparathyroidism. In recent years, advances in preoperative localizing techniques have led to the use of more targeted, minimally invasive procedures to remove parathyroid glands. We present our series of patients who underwent Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) procedures and our results in treating primary hyperparathyroidism. METHODS: Patients who underwent video-assisted parathyroidectomy were identified from a prospectively maintained database. Clinico-pathological data including indications for surgery, complications, conversion to open procedure and success of surgery were obtained from clinical notes. RESULTS: A total of 56 patients underwent MIVAP between 2002 and 2010 at a district general hospital setup. The clinical indication was diagnosed primary hyperparathyroidism. Preoperative localization was attempted in all patients by sestamibi and high resolution ultrasound scans. The median age of patients was 65 years (32-82) and the median operating time was 78 min (20-168). Conversion to open procedure was done in 8/56 (14%) cases. The reason for conversion was failed exploration in 5 patients, inability to retrieve a very large friable adenoma in one patient, lipo-adenoma in one patient and very small parathyroid adenoma in one patient. Postoperative complications happened in one patient (2%) who developed postoperative sepsis resulting in temporary recurrent laryngeal nerve (RLN) palsy. All but 5 patients became normo-calcaemic following surgery. CONCLUSION: MIVAP is a safe and effective procedure for treating patients with primary hyperparathyroidism. It also allows classical 4 gland exploration, whenever necessary.

Minimally invasive, video-assisted thyroidectomy: first experience from the United Kingdom.

INTRODUCTION: Minimally-invasive, video-assisted thyroidectomy (MIVAT) was developed to reduce scarring/trauma associated with cervical incisions used in open thyroidectomy. Results from various centres have been published internationally but none from the UK. This study reports the first results from the UK and compares them with other centres. We also aim to compare the results of a single-surgeon experience in a small/moderately-sized hospital to those of larger tertiary centres. PATIENTS AND METHODS: Retrospective analysis of a single surgeon experience in a district general hospital RESULTS: The cohort was 55 patients (52 female, 3 male), mean age 48 years (range, 21-77 years) who had 64 MIVAT procedures. There were 49 hemithyroidectomies (HTs), 2 isthmusectomy, 4 total thyroidectomies (TTs) and 9 completion thyroidectomies (CTs) with median operating time of 86 min (IQR 66-110 min). Individual operating times were HT 85 min (IQR 60-110 min); TT 130 min (IQR 100-140 min) and CT 77 min (IQR 70-98 min). Median operating time was shorter in the second half of this series (76 min vs 92 min; P < 0.001). Length of stay was < 1 day in 92%. Conversions occurred in 6.3% with no haematoma or re-operation. Transient voice change was present in 7 (11%), permanent unilateral recurrent laryngeal nerve palsy in 2 (3%), and transient hypocalcaemia in 2 (3%). CONCLUSIONS: The first results from the UK are similar to those of other international centres. A single-surgeon practice can obtain results comparable to larger tertiary centres provided there is sufficient case-load. MIVAT is safe and effective, but has a steep learning curve with rapid improvement observed within first 30 cases. Future studies should focus on objective assessment of scar/cosmesis and cost-effectiveness. MIVAT is an acceptable alternative to open surgery in highly selected patients.

Association of positive bile cultures with the magnitude of surgery and the patients' age.

Over a 5-year period we studied bile samples of 366 patients undergoing uncomplicated elective cholecystectomies, performed in the Southern General Hospital, Glasgow. The study aimed to establish the rate of positive bile cultures and the frequency and order of cultured organism therefrom, and to explore the relationship between positive cultures, magnitude of the surgery undertaken and age of patients. The results showed 17 different organisms in a variety of combinations. Culture was positive in 19.9% of cases, of which 69.9% grew one type of organism, 23.3% grew two types, and 6.8% grew more than two types. The number of positive cultures increased in relationship to the magnitude of the surgical procedure undertaken. Cultures were positive in 17.5% of cases undergoing simple cholecystectomy, 23.6% of cases undergoing cholecystectomy and cholangiography and 44.4% of cases undergoing cholecystectomy with exploration of the common bile duct (CBD). The rate of positive cultures also increased with increasing age, with a steep rise over the age of 60 years.

Abdominal aortic aneurysm: ten years' hospital population study in the city of Glasgow.

The study comprised 2936 cases of aortic aneurysm admitted to Glasgow City hospitals between January 1980 and December 1989. Information was first obtained from Scottish Morbidity Records 1 (SMR1), Scottish Hospital Inpatients Statistics, the accuracy of which was assessed by detailed inspection of 500 case notes, evenly distributed throughout the study period. The data from 489 of the 500 case notes examined matched the SMR1 data which was therefore accurate in 97.8% of cases. Of the 2936 cases, 852 (29%) had more than one admission with the same diagnosis in the same year and of the remaining 2084 cases 169 (8.1%) were thoracic aneurysms. After correction for these findings, 1915 abdominal aortic aneurysms (AAA) were left for the study. Of these, 618 (32.3%) were females giving a male to female approximate ratio of 2:1 which remained constant for each year of the study. The mean age of the study population increased from 70.3 years in 1980 to 72.3 years in 1989 with an overall mean of 71.2 years. There was a significant increase in the percentage of patients over the age of 75 years (from 17.4% in 1980 to 28.8% in 1989). Twenty-seven per cent of the cases (519 of 1915) were ruptured aneurysms. This was again stable for the 10 years of the study. Analysis of hospital mortality suggested better outcomes, both for ruptured and non-ruptured aneurysms, in the purely vascular unit of Glasgow as opposed to other surgical units in the city. The possible significance of this finding is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Glasgow aneurysm score.

A clinical prognostic scoring system for patients with abdominal aortic aneurysm and audit of the sequelae of a sample population in Glasgow, are described. Randomly selected case notes of 500 patients, representing 41.6% (500 of 1202) of the total population treated in Glasgow hospitals with general surgical units (as opposed to vascular units) between 1980 and 1990, were examined for risk factors. These were then related to the operative and postoperative hospital mortality. Initial univariate analysis showed the outcome to be significantly influenced by the following factors: age (P = < 0.01), rupture (P = < 0.001), shock (P = < 0.001), myocardial disease (P = 0.08), cerebrovascular disease (P = 0.03), renal disease (P = 0.03) and size of the aneurysm (P = 0.06). Using multivariate analysis, the following independent risk factors were identified: age (P = 0.02), shock (P = < 0.001), myocardial disease (P = 0.02), cerebrovascular disease (P = 0.02) and renal disease (P = 0.003). Rounding of the regression coefficients created a simple risk score: risk score = (age in years)+(17 for shock)+(7 for myocardial disease)+(10 for cerebrovascular disease)+(14 for renal disease). Subsequent evaluation of the scoring system showed that the mortality rate increases in proportion to the score. Other findings are analysed and discussed.

Abdominal aortic aneurysm in Scotland.

In the 12-year period to December 1991, 5338 new cases of abdominal aortic aneurysm (AAA) were recorded in the Scottish Morbidity Record (SMR) 1. Data from this source were analysed for accuracy; information from 489 of 500 randomly examined case records matched the SMR 1 data, giving an accuracy of 97.8 per cent. There was a steady yearly increase in the number of reported cases, from 283 in 1980 to 612 in 1991; the male to female ratio was 2.5:1. The mean age was 73.1 years, higher in women (73.4 years for intact and 77.2 years for ruptured aneurysm) than in men (69.8 and 71.8 years respectively). The proportion of patients aged over 75 years increased from 29.0 per cent in 1980 to 38.2 per cent in 1991. Rupture occurred in 36.4 per cent of the aneurysms, and 75.0 per cent of these were in men. The increase in numbers occurred in both intact and ruptured cases, particularly the former. The hospital mortality rate for Scotland was 10.5 per cent for intact AAA (including urgent non-ruptured cases) and 54.7 per cent for ruptured aneurysm (including those not operated on), but these figures varied markedly between health boards.

Infrageniculate vein bypass graft for critical limb ischaemia: one surgeon's experience.

The results of 63 patients under the care of one surgeon who underwent a bypass, using vein, for critical limb ischaemia are presented. Thirty-two operations were to the crural vessels and the results are compared with those for 31 infrageniculate femoropopliteal bypasses. All patients were entered into a graft surveillance programme. There were no graft failures after 1 year in the femoropopliteal group with primary, primary assisted and secondary patency rates of 86, 90 and 93% respectively at 3 years. In the femorocrural group the rates were 55, 60 and 64% respectively. The difference in secondary patency was considered statistically significant (P < 0.01). Mortality rate of the femoropopliteal group was 31% at 3 years compared with 53% for the femorocrural group (n.s.). Five patients underwent major amputation, all of whom were in the femorocrural group. Failures, interventions and the effect of graft surveillance are discussed and the high mortality rate is highlighted.

Prospective evaluation of the Glasgow Aneurysm Score.

The Glasgow Aneurysm Score (GAS), developed and published by the same authors, is a clinical prognostic scoring system that predicts mortality when operating on either intact or ruptured abdominal aortic aneurysms (AAA) taking into account these clinical criteria: patient's age, shock at presentation, myocardial disease, cerebrovascular disease and renal disease. The GAS was prospectively evaluated by studying 320 consecutive patients with AAA who were operated on at Glasgow, Aberdeen and Inverness, Scotland, in the period between January 1990 and May 1993. Logistic regression analysis showed very similar results to the original analysis used in developing the score. Age, shock, myocardial disease and renal disease were highly significant. Although it was not significant, cerebrovascular disease weight was not significantly different to its value in the original analysis. The mortality correlated well with the values of the score and ranged from 0% for scores below '70 GAS' to 80% for scores over '95 GAS'. The GAS appears, therefore, to be a reliable clinical predicative tool in foretelling the outcome of operating on AAA in terms of operative in-hospital mortality.

Abdominal aortic aneurysm: a 12-year experience in the Grampian region, Scotland.

All the 638 new hospital cases of abdominal aortic aneurysm (AAA) diagnosed in the Grampian region of Scotland, over the 12-year period between January 1980 and December 1991, were studied. Information was obtained from the Scottish Morbidity Record Form 1 (SMR1). The number of AAA cases has risen from 19 in 1980 to 84 in 1991 totalling 638 cases in the 12-year study period. Of these, 29% were women, a percentage which remained fairly constant for each year of the study. The mean age of the study population was 73.8 years; higher in women (74.7 in intact and 76.6 in ruptured cases) than in men (71 in intact and 73.1 in ruptured cases). There was a significant increase in the percentage of patients over the age of 75 years (from 31.6% in 1980 to 41.7% in 1991) which was very marked in men (from 25% to 40%). This may indicate that ageing of the population is partly responsible for the apparent increased incidence of the disease. Ruptured AAA constituted 36.5% of all cases of which 76.4% were men. The rate of ruptured cases has dropped from 73.7% in 1980 to 32.1% in 1991 probably owing to operating on more elective cases. Analysis of hospital fatality, including unoperated cases, showed a fatality rate of 8.4% for intact cases as opposed to 46.3% for ruptured cases. Allowing for improved diagnostic techniques and clinical awareness of the disease, the figures suggest a true increase in the incidence of AAA in the Grampian region.