• Radu Mihai, Mary Weisters, Michael J Stechman, Fergus Gleeson, and Greg Sadler.
• Department of Surgery-level 2, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. radumihai@doctors.org.uk
• Langenbecks Arch Surg. 2008 Sep 1;393(5):739-43.

BackgroundConcordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT).AimTo investigate the financial implications of scan-directed parathyroid surgery.MethodsAnalysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre.ResultsTwo hundred patients (138F:62M, age 18-91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 +/- 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 +/- 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used ( approximately 1.3days/patient). The estimated total costs incurred were pound215,035 ( approximately 290,000). These costs would have been covered by the National Tariff ( pound2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations ( pound166,000 approximately 224,100euro).ConclusionShorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.

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