Minimally Invasive Video‐assisted Parathyroidectomy: Multiinstitutional Study

Abstract

Unilateral and minimally invasive parathyroidectomies with endoscopic and video-assisted technique have been introduced. Most of these procedures utilize preoperative localization and intraoperative monitoring of parathyroid hormone. There are only a few reports on these procedures. The objective of this study was to evaluate video-assisted parathyroidectomy (MIVAP) for surgery in patients with primary hyperparathyroidism (pHPT). From February 1997 to June 1999 a series of 123 consecutive patients with pHPT at four surgical centers were evaluated. The patients' ages ranged from 18 to 77 years (median 50 years). Preoperatively, sestamibi scintigraphy and ultrasonography for localization were performed for all patients. Selection criteria for a MIVAP procedure excluded patients with negative localization, suspicion of multiglandular disease (MGD) or thyroid malignancy, a large thyroid mass, and prior surgery or irradiation to the neck. MIVAP was performed with a 1.5 cm suprasternal incision; the operation was then done through this incision with a 30 degree 5 mm endoscope and microsurgical instruments with brief CO2 insufflation for adenoma identification. We then proceeded with an open technique through the small incision under video-assistance. Intraoperative monitoring of intact parathyroid hormone (iPTH) assays was used in all patients. Among the 123 patients in whom MIVAP was attempted, the procedure was accomplished in 109 (89%). Conversion to conventional cervicotomy was required in 14 (11%) patients because of failed localization, failure of the iPTH level to fall appropriately, or technical problems. There was no persistent or recurrent HPT during the 3 to 12-month follow-up. Oral calcium replacement for symptomatic hypocalcemia postoperatively was given in 7 (6%) cases. A unilateral transient laryngeal nerve palsy, resolving within 6 months postoperatively, occurred in two (2%) patients. The median hospital stay was 1.5 days (range 0.5-5.0 days). This study showed the feasibility of MIVAP as an alternative surgical treatment for pHPT in a selected group of patients. Further studies are necessary to evaluate the efficacy and rationale of MIVAP compared to other techniques for parathyroidectomy in pHPT patients.

Advantages of a Video-Assisted Approach to Parathyroidectomy

“…This has been extensively demonstrated in the world literature [20,26,40] and it is evident from our personal experience, which is herein reported. In this series cure rate was 98.1%.…”

“…VAP gained wide diffusion in several referral centers [16,20,26,[36][37][38] shortly after its first description. There are several reasons for the success of VAP, but first of all, it combines the advantages related to endoscopic magnification (i.e.…”

“…Moreover, when evaluating a surgical procedure also the reproducibility in different surgical settings and the technical aspects should be considered [26] . Procedures that are difficult to be reproduced in different centers or that are technically demanding have a limited diffusion and are usually confined to the proponents.…”

Parathyroid Imaging with SPECT-CT

“…Therapeutic procedures are often demanding for highly accurate pre-therapeutic imaging, allowing detection and localization of abnormal parathyroid gland tissue accurately. Especially the recently developed minimally invasive surgical techniques require reliable preoperative disease localization [3,4].…”

Clinical Value and Limitations of [11C]-Methionine PET for Detection and Localization of Suspected Parathyroid Adenomas

“…Both therapeutic procedures are demanding for pretherapeutical imaging methods to detect and locate abnormal parathyroid gland tissue accurately. Especially the recently developed minimally invasive surgical techniques require reliable preoperative disease localization [2,3].…”