Intercostal Video-Assisted Mediastinal Surgery through an intercostal window (IVAMS): A simpler approach to perform mediastinal parathyroidectomy

The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients

“…In the recent years, mini-or less-invasive approaches alternative to open sterno-thoracotomic parathyroidectomy have been proposed, including videothoracoscopic or robotassisted procedures [3,6,8,18,33], transcervical or intercostal mediastinal video-assisted parathyroidectomy [21,34]. Minimally invasive and video-assisted mediastinal parathyroidectomy has been clearly associated to lower morbidity and shorter hospital stay [3,6,8].…”

“…Thoracoscopy has been suggested as the technique of choice for ectopic glands located to the middle and lower mediastinal regions; some limitations have been reported in case of immediately retrosternal parathyroids in the upper part of the anterior mediastinum, with an increased risk of convertion [3,6,8,22,23]. However, thoracoscopic approach may be laborious; it requires single-lung ventilation, pleural incision, and cannot be safely performed in patients with compromised pulmonary function or chest adhesions [20,21]. To the contrary, video-assisted transcervical approaches may be still less invasive, since the selective single-lung ventilation may be avoided; surgery may be performed with the patient in classic supine position with a comfortable incision, without violation of the pleural space [34]; operative time are comparable to thoracoscopic procedures [20], while some difficulties have been reported to excise deep glands in the posterior mediastinum [6,13,21].…”

“…However, thoracoscopic approach may be laborious; it requires single-lung ventilation, pleural incision, and cannot be safely performed in patients with compromised pulmonary function or chest adhesions [20,21]. To the contrary, video-assisted transcervical approaches may be still less invasive, since the selective single-lung ventilation may be avoided; surgery may be performed with the patient in classic supine position with a comfortable incision, without violation of the pleural space [34]; operative time are comparable to thoracoscopic procedures [20], while some difficulties have been reported to excise deep glands in the posterior mediastinum [6,13,21]. In our experience, although limited, thoracoscopic exploration was preferred for lower and anterior mediastinal parathyroids, while the transcervical video-assisted mediastinal exploration was preferred in upper anterior and posterior locations.…”

“…In the recent years, following the increased accuracy of preoperative localization studies and the availability of video-assisted techniques, alternative minimally invasive techniques such as mediastinoscopic or thoracoscopic exploration have been proposed [3,8,13,[21][22][23].…”