Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism

Miccoli, Paolo; Pinchera, Aldo; Cecchini, G.; Conte, Massimo; Bendinelli, Cino; Vignali, Edda; Picone, A; Marcocci, Claudio

doi:10.1007/bf03347996

Cited by 194 publications

(130 citation statements)

References 3 publications

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“…A considerable recent surge has occurred in the development of endoscopic techniques in thyroid surgery. Since Gagner (7) and Hüscher et al (1) first reported successful endoscopic neck surgery in 1996 and 1997, several endoscopic thyroid surgical techniques have been developed (8)(9)(10)(11)(12)(13)(14). Minimizing surgical stress, cosmetic concerns and improving the postoperative quality of life are the main motivations for developing novel endoscopic thyroid surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: A retrospective study of a 4-year experience

Cao¹,

Xie²,

Cui³

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. Endoscopic thyroidectomy (ET) allows surgeons to remove a thyroid tumor from a remote site, while providing excellent results from a cosmetic viewpoint. The aim of this study was to explore the appropriateness and outcomes of ET via breast approach for the treatment of benign thyroid tumors. A total of 637 patients with benign thyroid tumors were recruited in our department. Two hundred and eighty-five patients underwent the ET via breast approach (ET group) and 352 matched control patients underwent conventional thyroidectomy (ConT group). Variables, such as surgery-related outcomes and postoperative complications, were compared between these two groups. A unilateral lobectomy was performed in 126 patients (44.2%) of the ET group and in 163 patients (46.3%) of the ConT group. A bilateral total thyroidectomy was performed in 159 patients (55.8%) of the ET group and in 189 patients (53.7%) of the ConT group. The operative time in the ET group was longer compared to the ConT group (79.9±20.10 vs. 45.4±11.90 min, P<0.001, for unilateral lobectomy; and 89.9±14.60 vs. 60.0±8.44 min, P<0.001, for bilateral total thyroidectomy). The ET group had a significantly longer mean hospital stay compared to the ConT group (5.5±0.50 vs. 5.3±0.75 days, P=0.002). There was no case of conversion to conventional open surgery in the ET group. The recurrent laryngeal nerves and parathyroid glands were identified and protected in all cases. Our results indicate that ET performed via breast is a technically feasible and safe procedure with excellent cosmetic results for patients with benign thyroid tumors.

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Section: Discussionmentioning

confidence: 99%

Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: A retrospective study of a 4-year experience

Cao¹,

Xie²,

Cui³

et al. 2011

Experimental and Therapeutic Medicine

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“…However, with the wide use of sensitive preoperative localization studies some surgeons have advocated the use of a unilateral Figure 1 Plasma PTH (percent of the highest pre-excision value) in the 22 patients with a .50% decrease at T-10, but not at T-5. approach (11 -13), or even minimally invasive (14), video-assisted parathyroid surgery (10,15), the potential benefits of these procedures being the decreased risk of postoperative hypocalcemia, nerve injury and shorter operating time (16 -18). The main limitation of these latter procedures is the possibility of a multiglandular disease in up to 15 -20% of cases of sporadic PHPT, a condition that cannot often be identified preoperatively (5,6).…”

Section: Discussionmentioning

confidence: 99%

“…One hundred and thirty patients, selected on the basis of preoperative imaging (neck ultrasound and/or 99m Tc-sestamibi) indicating the presence of a single adenoma, absence of goiter, and no previous neck surgery, underwent minimally invasive video-assisted parathyroidectomy (10), and 76 underwent a standard cervical approach. A suspected enlarged parathyroid gland was removed and submitted to frozen section only if the QPTH intraoperative measurement did not show a significant decrease (see below); normal-looking glands were not routinely biopsied.…”

Section: Patientsmentioning

confidence: 99%

A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases

Vignali

Picone

Materazzi

et al. 2002

European Journal of Endocrinology

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Objective: The traditional surgical approach for patients with primary hyperparathyroidism (PHPT) consists of the identification of at least four glands and in the removal of all hyperfunctioning parathyroid tissue. Design: To evaluate whether intraoperative parathyroid hormone (PTH) monitoring will allow a more limited surgical procedure by confirming complete removal of all hyperfunctioning tissue. Methods: Plasma samples were obtained from 206 consecutive patients with sporadic PHPT before skin incision, during manipulation of a suspected adenoma, and 5 min (T-5) and 10 min after removal of abnormal parathyroid tissue. PTH was measured by a quick immunochemiluminescent assay (QPTH). The operative success was defined by a decrease of PTH greater than 50% of the highest pre-excision value. Results: A .50% decrease of PTH occurred in 203 patients and was evident at T-5 in the majority of cases. All but three had normal serum calcium the day after surgery and afterwards. PTH concentration did not show a . 50% decrease in the remaining three cases after completion of surgery. One patients had negative neck exploration and remained hypercalcemic; the other two had normal serum calcium at follow-up. Thus, the intraoperative QPTH correctly predicted the outcome of surgery in 201 patients (97.5%) (200 true positive and 1 true negative), and provided three false positive and two false negative results. Conclusions: The intraoperative QPTH measurement represents a useful tool to assist the surgeon during parathyroidectomy. It indicates whether all hyperfunctioning parathyroid tissue has been removed, limiting the procedure to a unilateral neck exploration in most cases.

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“…Many reports on the use of this technique in thyroid surgery, particularly for eliminating the unattractive scars sometimes caused by conventional surgery, have been published. [1][2][3][4][5][6][7][8][9][10][11] Minimal-access thyroid surgery was conceived primarily in Europe and Asia. A number of groups [11][12][13][14][15][16][17] have made pioneering contributions to this field.…”

Section: Introductionmentioning

confidence: 99%

Comparison of minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a single-blinded, randomized controlled clinical trial

Ellabban¹

2010

OAS

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Aim:We aimed to test the hypothesis that minimally invasive video-assisted thyroidectomy (MIVAT) affords comparable safety and efficacy as open conventional surgery in patients with unilateral thyroid nodules or follicular lesions in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain, and hospital stay. Methods: A single-blinded randomized controlled trial compared MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours and cosmetic outcome 3 months postoperatively. The secondary outcome measures were operative time, incidence of recurrent laryngeal nerve injury, length of incision, and hospital stay. Results: Operative time was less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Pain score showed statistically significant differences in favor of MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfaction with cosmetic results. There was no difference between both procedures for presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. Conclusion: MIVAT is a safe procedure that produces outcomes similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results

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Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism

Cited by 194 publications

References 3 publications

Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: A retrospective study of a 4-year experience

Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: A retrospective study of a 4-year experience

A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases

Comparison of minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a single-blinded, randomized controlled clinical trial

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