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Complications - Heterotopic parathyroid autotransplantation in total parathyroidectomy

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative complications

    • Signal loss during IONM
    • If this happens on the first side in a planned bilateral procedure, do not resect the contralateral side because otherwise this runs the risk of bilateral recurrent laryngeal nerve paralysis.
    • Bleeding
    • Manage massive intraoperative hemorrhage (e.g., from the Kocher vein or inferior thyroid artery) first by packing, then identify the bleeder under continuous suction, clamp and ligate it.
    • Missed parathyroids
    • When no altered parathyroid tissue is found or glands are missing: Terminate the procedure and perform detailed diagnostic work-up

  2. Postoperative complications

    • Secondary bleeding
    • Deep secondary bleeding may compress the trachea and vagus nerve, thereby resulting in a life-threatening situation. This mandates stat revision surgery.
    • Vocal cord paralysis
    • Since in most cases vocal cord paralysis results from nerve compression or strain, division of the nerve is less common and the paralysis may resolve. However, bilateral total paralysis of the vocal cords may necessitate tracheotomy.
    • Permanent hypoparathyroidism
    • Life-long substitution of calcium
    • Persistent/recurrent PHPT
    • Extended diagnostic work-up, possibly intraoperative PTH study of the bilateral jugular blood. Possibly PTH selective venous sampling ruling out/confirming a mediastinal parathyroid mass not accessible from the neck.