Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: A South Indian experience

Bhargav, Panchangam Ramakanth; Mayilvaganan, Sabaretnam; Vennapusa, Amar; Devi, Nangedda Vimala

doi:10.4103/jmas.jmas_264_17

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…However, the feasibility of parathyroidectomy by the transoral vestibular approach has also been demonstrated by several groups. 23,24 Bhargava et al have also demonstrated that with proper case selection, the transoral TOEPVA technique is an alternative for parathyroidectomy especially for unigland sporadic primary hyoerparathyroidism. 25 Transient recurrent laryngeal nerve palsy was reported in one case by Karakas et al One of our patients who developed recurrent laryngeal nerve paresis in the postoperative period recovered over a period of time.…”

Section: Discussionmentioning

confidence: 99%

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

Gajbhiye

Deshpande

Tirpude

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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Background: It has been debated that "remote access endoscopic parathyroidectomy" requires extensive dissection, thereby, increasing the risk of complications. Hence, the aim of this study is to assess the feasibility and safety of remote access endoscopic parathyroidectomy via the unilateral axilla-breast approach (ABA) and transoral vestibular approach (TOEPVA). Method: The study includes 17 patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy from January 2016 to December 2020. Of these, 11 patients underwent parathyroidectomy via unilateral ABA and 6 had TOEPVA. Preoperatively, ultrasonography of neck, sestamibi scan and CT scan neck were done to localise the diseased gland. Post operatively, Serum calcium and parathyroid hormone levels were monitored.Results: The mean age of patients was 35.6±10.5 years. Except one, all the patients were females. The mean operative time of the unilateral ABA and TOEPVA group was 93.67±28.64 minutes and 138.6±31 minutes respectively. Except for three patients, in all the patients, the parathormone levels normalised. One patient had hungry bone syndrome postoperatively. The mean hospital stay of the unilateral ABA and TOEPVA group was 3±1.5 days and 4±3.09 days respectively. One patient had post-operative transient recurrent laryngeal nerve paresis. Seroma and surgical emphysema were seen in two patients each. Conclusions: Remote Access Endoscopic parathyroidectomy may be considered safe in treatment of parathyroid tumours. Precise preoperative localisation is mandatory. In addition to a magnified view and a better illumination, the potential advantages of endoscopic techniques are better cosmetic results, decreased hospital stay and better patient comfort.

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Section: Discussionmentioning

confidence: 99%

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

Gajbhiye

Deshpande

Tirpude

et al. 2021

Int J Otorhinolaryngol Head Neck Surg

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“…No mental nerve injury or infections were seen. Recently, another report from India was published[ 13 ]. This study included 12 patients with PHPT who underwent transoral endoscopic vestibular parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Transoral parathyroidectomy was first described through the mouth floor but was not widely accepted due to complications and poor patient compliance[ 7 - 9 ]. Endoscopic transoral vestibular parathyroidectomy is a feasible and safe technique, which provides a direct approach to the glands with excellent cosmetic results[ 10 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature

Özdenkaya

Ersavas

Arslan

2018

WJCC

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Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.

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“…After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical disease [1]. It occurs either from a disorder within the parathyroid glands (primary hyperparathyroidism) or disorder outside the parathyroid glands (secondary or tertiary hyperparathyroidism) [2].…”

Section: Introductionmentioning

confidence: 99%

“…After, realisation of that a single adenoma is the cause of hyperparathyroidism in most of the patients (80-85%), surgical management was changed significantly [2]. With preoperative imaging tools (ultrasound and technetium-99m sestamibi scintigraphy) for localisation of the adenoma and intraoperative parathyroid hormone level measurements for confirmation, surgical excision of the offending parathyroid adenoma is still accepted as the main treatment of primary hyperparathyroidism [1,2,5].…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Yilmaz

Baş

2020

Preprint

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Introduction: After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical disease. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have been led to development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anaesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Material-method: Patients undergo TOEPVA at the Health Sciences University Izmir Bozyaka Training and Research Hospital between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Seven patients were operated successfully by this technique none of which required conversion to conventional open surgery. Two patient required atropine and one patient required ephedrine during insufflation. Conclusion: After induction of anaesthesia with propofol, remifentanil and rocuronium; anaesthesia managed by desflurane co-administered with continous infusion of remifentanil, provide feasible and safe anaesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anaesthetist have a great value to improve patient management.

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Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: A South Indian experience

Abstract: Through this study, we opine that this novel transoral vestibular route parathyroidectomy is a feasibly applicable approach for primary sporadic hyperparathyroidism, especially with solitary benign adenomas.

Cited by 14 publications

References 22 publications

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

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