Scoping review of approaches used for remote‐access parathyroidectomy: A contemporary review of techniques, tools, pros and cons

Abstract

After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.

Management of surgical diseases of Primary Hyperparathyroidism: indications of the United Italian Society of Endocrine Surgery (SIUEC)

“…All these approaches have their own advantages and disadvantages. Despite their diffusion was limited since their introduction, the available data suggest that the cure rate and the safety of such techniques are similar to those of minimally invasive and conventional approaches [ 36 ]. Nonetheless, the available data are few and their definitive role in the clinical practice is still far from being defined.…”

Parathyroidectomy for solitary parathyroid adenoma via trans‐areola single site endoscopic approach: Results of a case‐match study

“…However, open parathyroid surgery inevitably came with a conspicuous scar in the anterior neck area and suboptimal cosmesis 7–9,25,26 . Since the first report of transcervical total endoscopic parathyroidectomy in 1996, 27 parathyroidectomy via endoscopic approach has been unremittingly attempted in pursuing for improved cosmetic expectations, less postoperative pain, and enhanced recovery 18,20,21,28,29 . On the other hand, there remained controversy over whether multiple‐site endoscopic approach might overlook the potential higher surgical burden to obtain limited cosmetic effects.…”

“… 7 , 8 , 9 , 25 , 26 Since the first report of transcervical total endoscopic parathyroidectomy in 1996, 27 parathyroidectomy via endoscopic approach has been unremittingly attempted in pursuing for improved cosmetic expectations, less postoperative pain, and enhanced recovery. 18 , 20 , 21 , 28 , 29 On the other hand, there remained controversy over whether multiple‐site endoscopic approach might overlook the potential higher surgical burden to obtain limited cosmetic effects. In this regard, single‐site endoscopic techniques were initiated to further minimize the invasiveness of surgical interventions.…”