Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution

Introduction: Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision. Methods: In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5\ua0min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n\ua0=\ua0190) undergoing a standard immediate autotransplantation. Results: We divided patients in two main groups: group A (n\ua0=\ua0160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n\ua0=\ua0236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P\ua0<\ua00.001): 91.9\ua0% were transient and 8.1\ua0% (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P\ua0=\ua00.616 vs. group A and P\ua0=\ua00.002 vs. group B) and 3/42 became definitive (P\ua0=\ua00.096 vs. group A and P\ua0=\ua00.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P\ua0<\ua00.001). Conclusions: We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation