Parathyroid Surgery Center Opens at St. Anthony Community Hospital
Thursday, April 01, 2010
Parathyroid glands — the small glands of the endocrine system located just behind the thyroid — make parathyroid hormone (PTH), which regulates the level of calcium in the blood.
Photo: Don Dempsey, White Light Photography
Other cells in the body, especially those in the bones, kidneys and small intestine, respond to PTH by increasing the level of calcium in the blood. Patients can develop primary hyperparathyroidism when one or more of the parathyroid glands enlarge, become overactive and secrete excessive PTH. When this occurs, a tumor or parathyroid adenoma will develop.
Parathyroid Adenoma
More than 95% of parathyroid adenomas are benign, so the risk of developing parathyroid cancer is low. About four of every 100,000 people will develop the disorder, which increases with age and affects women twice as frequently as men. When parathyroid adenomas are present, patients often suffer with bone pain, osteoporosis, kidney stones and abdominal discomfort. Those that are asymptomatic and have mildly elevated calcium levels can sometimes be monitored or treated with medications, but for most patients with this condition and those with unacceptably high calcium levels, a parathyroidectomy is necessary to remove the parathyroid adenoma.
New York Center for Advanced Parathyroid Surgery
Lawrence Gordon, M.D., Chief Surgeon at the New York Center for Advanced Parathyroid Surgery, which opened several months ago at St. Anthony Community Hospital in Warwick, says, “There is uniform agreement in the medical profession that patients with primary hyperparathyroidism will require surgery to remove abnormal parathyroid adenomas.” A board-certified head and neck surgeon, Dr. Gordon specializes in parathyroid and thyroid surgery and has over 15 years of experience performing different types of surgeries to treat the disorder. “Our new center is really unique. We have created a multidisciplinary team of surgeons, radiologists, pathologists, technicians and nurses that come together to provide the very best care for parathyroid disorders that is clearly a step above other community and university hospitals,” says Dr. Gordon. “Our highly efficient system has enabled us to produce very definable patient outcomes. The pursuit of excellence is the goal of everyone on our team, and it’s such an exciting environment to work in.”
Good Diagnostic Tests Are Essential
“One thing that has always bothered me in medicine is the variability that exists with diagnostic tests. For example, the ability to perform a good parathyroid scan or an ultrasound really varies and depends heavily on the skills and experience of the technician,” explains Dr. Gordon. “The technician needs to know exactly what to do and have the right equipment and processes in order to produce the best diagnostic outcomes. This skill is essential because it has a direct affect on the surgery we perform. Without good diagnostic tests, we can’t deliver our best results as surgeons.
“During the last 10 years, the ability to explore the neck and to locate the parathyroid glands has vastly improved. When I trained to be a physician, there were few tools available to help localize adenomas. The only technology we really had back then was ultrasound, and unfortunately, the level of success we had in identifying tumors with this type of equipment was very low,” explains Dr. Gordon, “but today’s high-tech ultrasound machines and probes provide much better resolution.”
State-of-the-Art Technologies
The Center for Advanced Parathyroid Surgery has the latest imaging technologies, which enables the technicians and surgeons at St. Anthony to pinpoint parathyroid abnormalities with precise accuracy. “I believe it is critical to have the best technologies available so that you can localize the patient’s adenoma. This enables us to operate using a minimally invasive approach,” says Dr. Gordon. Imaging services available include Sestamibi scans, the latest ultrasound machines, SPECT scans, MRI and high resolution CT. Behind this state-of-the-art technology are highly trained, experienced technicians who specialize in exploring and identifying parathyroid abnormalities. “Because our technicians concentrate only on parathyroid disorders, they know exactly what to look for when they work on patients,” says Dr. Gordon.
A Sestamibi scan is a nuclear medicine procedure that is performed to identify parathyroid adenomas. Sestamibi is a nuclear radiopharmaceutical, which is bound to the radioactive isotope technetium-99. When this mild radioactive agent is injected into the patient’s veins, it is absorbed at a greater rate in an overactive parathyroid gland than in a normal parathyroid gland.
“Before we perform parathyroid surgery, we always do a parathyroid Sestamibi scan,” says Dr. Gordon. “It’s very important to have this procedure done by a facility that is highly experienced in performing these types of nuclear studies. When we review our patient’s Sestamibi scans that were done at other hospitals, we frequently find false negative outcomes because so many hospitals really don’t perform these scans on a regular basis. When we repeat the scan at our center, the test result is frequently positive. I believe that if a Sestamibi scan is done properly, coupled with a high sensitivity ultrasound test, it enables our surgeons to localize the parathyroid adenoma in over 85% of cases. When you have control over who is doing the imaging work, you can provide the best care possible.”
“In a very small percentage of cases, when other imaging modalities fail to localize the parathyroid adenoma, we will perform a high resolution CT or a T2 weighted MRI scan but these tests are reserved for difficult cases,” says Dr. Gordon. “We will also use high resolution ultrasound machines in conjunction with Technetium Sestamibi scans. “The ultrasound provides us with the anatomic size and location of the adenoma. The Sestamibi nuclear scan measures the activity of the adenoma. Dr. Gordon also performs ultrasound imaging during surgery to confirm the position of a parathyroid tumor. “I believe surgeon-performed ultrasound helps ensure the highest success rate when performing minimally invasive parathyroid surgery,” notes Dr. Gordon.”
Single photon emission computed tomography (SPECT) scanning provides a 3-D image of the parathyroid and can be performed after technetium-99 Sestamibi is injected. “The SPECT scan method is 2 to 3% more accurate than a standard parathyroid scan,” notes Dr. Gordon. During the scan, many images are taken at different angles around the patient’s head.
“We typically reserve this technique if a Sestamibi scan was performed at another hospital and was found to be negative,” explains Dr. Gordon.
Minimally Invasive Surgery
Dr. Gordon uses a minimally invasive technique in 95% of the parathyroid surgeries he performs at the New York Center for Advanced Parathyroid Surgery. “The only time I will use a traditional open method is when I cannot locate the adenoma with scans or ultrasound. After intraoperative localization with high-resolution ultrasound, I make a tiny incision over the abnormal parathyroid gland. This technique delivers excellent results and significant benefits for patients because the surgery is much shorter, actually 20 minutes from open to close,” notes Dr. Gordon. “In the past, a traditional open method could take up to two hours to perform. Less invasive surgery enables us to plan for shorter anesthesia, which means less risk and nausea for the patient. In addition, there is less trauma and manipulation to the patient’s neck, and because they have minimal bleeding, we don’t need to use a drain. Patients can return home the same day as their surgery with less pain and discomfort.” Because Dr. Gordon is also trained in plastic surgery of the head and neck, he can make meticulous incision lines that deliver excellent cosmetic results for patients. “Every patient has a natural skin crease in the neck area, and if you know what you’re doing, the size of the incision doesn’t have to be very large, he explains.” Dr. Gordon trained under John Connely, M.D., and Hyun Cho, M.D., two notable head and neck surgeons.
Coordinated Care Delivers the Best Results
“I believe the New York Center for Advanced Parathyroid Surgery is the premier place to receive care for parathyroid disorders. We focus on only one type of surgery, and that’s parathyroid surgery,” says Dr. Gordon. “This enables us to produce superior results while providing personalized care for every patient we treat. We use the right equipment and protocols and our success rate is much higher than other hospitals.
“Our program is designed to deliver efficiencies in everything we do. For example, all imaging modalities are conveniently located right next to each other,” explains Dr. Gordon. “Patients won’t need to return on another day to get the scans they need because we coordinate all imaging modalities with one appointment. In fact, we can perform any required imaging in just two hours. Our labs and operating rooms are also right next to each other, and my office is also close by, and unlike some facilities, our patients are never lost on another floor or kept waiting. Frequently, we perform the parathyroid imaging the same morning as the patient’s surgeries.
“Our multidisciplinary team at the New York Center for Advanced Parathyroid Surgery focuses on delivering the very best results for our patients. We bring our physicians, pathologists, radiologists surgeons, anesthesiologists and nurses together to determine the optimum care that’s needed for each patient,” says Dr. Gordon. “I think we bring high-quality care to another level at our center because we focus solely on parathyroid disease. Although a surgeon’s role is important, I actually believe too much weight is placed on surgery alone. What’s just as important is to have the correct diagnostic imaging and lab work and to ensure that we have a highly coordinated system to provide the best care and that the entire team gets everything right,” emphasizes Dr. Gordon. “This is especially true for parathyroid surgery, and because of the systematic approach and expertise we offer, we are able to localize 95% of the parathyroid adenomas we image, compared to 50% that are identified across all community and teaching hospitals. I believe that our ability to identify adenomas certainly makes my job much easier.”
Emerging Trends
Dr. Gordon is ardent that the future of health care will be one where providers compete on value. “Why should patients settle for a 70% success rate when they can get 95 to 99%,” he says. “I believe that competition will be based on the quality of care that is delivered through a highly efficient, coordinated system. Our center is an excellent example of this model. We are structured for success because we bring together a group of experts in parathyroid surgery that are singularly focused on treating hyperparathyroidism, and we work within a highly organized system that is specifically designed to provide the highest quality of care for parathyroid patients.”
A sports enthusiast, Dr. Gordon engages in several zealous hobbies. When he’s not in the operating room, you’ll likely find him rock or mountain climbing, skiing or playing tennis. Last year, he climbed Mount Elbrus, an active volcano and the tallest peak in Russia. He is also the father of four children. In addition to his role as Chief Surgeon, Dr. Gordon is also Chief Executive Officer of Waiting Room Solutions, which provides integrated Web-based electronic medical records and practice management solutions for physician offices.
MD News April 2010