The Technique of Endoscopic Exploration for Parathyroid Adenoma of the Neck

Yeung, Gustus; Ng, Jack

doi:10.1111/j.1445-2197.1998.tb04727.x

Cited by 59 publications

(31 citation statements)

References 6 publications

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“…These endoscopic techniques can be performed by gasless video-assisted methods, such as the minimally invasive video assisted parathyroidectomy (MIVAP) technique 29,30, or completely endoscopically, and through a variety of approaches to including cervical27,28, as well as axillary31, and breast32 approaches.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Minimally Invasive Video-Assisted Parathyroidectomy and Traditional Parathyroidectomy for Parathyroid Adenoma

Río¹,

Vicente²,

Maestroni³

et al. 2013

J. Cancer

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Background: Pre-operative imaging techniques for sporadic primary hyperparathyroidism (SPHPT) and intraoperative parathyroid hormone (ioPTH) have led to the wide spread use of minimally invasive surgical approaches.Study Design: In our prospectively collected database, 157 subjects with SPHPT and a preoperative diagnosis of parathyroid adenoma were treated with parathyroidectomy between January 2003 and November 2011. Subjects in group A were enrolled between January 2003 to September 2006, and underwent traditional parathyroidectomy with intraoperative frozen section and bilateral neck exploration. Subjects in group B were enrolled between September 2006 to November 2011, and underwent minimally invasive video-assisted parathyroidectomy (MIVAP) with ioPTH. Operative times and post-operative pain levels were compared between groups. Subjects were followed for a minimum of 6 months post-operatively and recurrence rates and complication rates were measured between groups.Results: 81 subjects were enrolled in group A, and 76 subjects were enrolled in group B. Pre-operative evaluation demonstrated that the groups were statistically similar. Significantly decreased operative times (28min vs. 62min) and post-operative pain levels were noted in group B. Recurrence rates were similar between group A (3.7%) and group B (2.6%).Conclusions: MIVAP with ioPTH demonstrated significantly improved operative times and post-operative pain levels, while maintaining equivalent recurrence rates.

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Section: Introductionmentioning

confidence: 99%

A Comparison of Minimally Invasive Video-Assisted Parathyroidectomy and Traditional Parathyroidectomy for Parathyroid Adenoma

Río¹,

Vicente²,

Maestroni³

et al. 2013

J. Cancer

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“…Over the past ten years, several different approaches of MIP have been described. These include total endoscopic parathyroidectomy, video-assisted techniques, radio-guided explorations and focused parathyroidectomy using mini-incisions either by a central or lateral approach directly over the adenoma [3,5-8]. All these techniques have considerable advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism

et al. 2009

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Background The former standard surgical treatment in patients with primary hyperparathyroidism (pHPT) has been bilateral cervical exploration. New localization techniques and the possibility of intraoperative measurement of intact parathormone (iPTH) permit a focused, minimally invasive parathyroidectomy (MIP). The introduction of MIP without complete neck exploration leads to the potential risk of missing thyroid pathology. The aim of the present study is to evaluate the value of MIP in respect to coexisting thyroid findings and their impact on preoperative workup for primary hyperparathyroidism. Methods This is a prospective study including 30 consecutive patients with pHPT (median age 65 years; 17 females, 13 males). In all patients preoperative localization was performed by ultrasonography and 99m Tc-MIBI scintigraphy-Intraoperative iPTH monitoring was routinely done. Results Ten patients (33%) had a concurrent thyroid finding requiring additional thyroid surgery, and two patients (7%) with negative localization results underwent bilateral neck exploration. Therefore, MIP was attempted in 18 (60%) patients. The conversion rate to a four gland exploration was 6% (1/18). The sensitivities of 99m Tc-MIBI scanning and ultrasonography were 83.3% and 76.6%, respectively. The respective accuracy rates were 83.3% and 76.6%. Of note, the combination of the two modalities did not improve the sensitivity and accuracy in our patient population. During a median follow-up of 40 months, none of the patients developed persistent or recurrent hypocalcaemia, resulting in a 100% cure rate. Conclusion Coexisting thyroid pathology is relatively frequent in patients with pHPT in our region. Among patients having pHPT without any thyroid pathology, the adenoma localization is correct with either ultrasonography or 99m Tc-MIBI scintigraphy in the majority of cases. MIP with iPTH monitoring are highly successful in this group of patients and this operative technique should be the method of choice.

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“…Another group reported 3 studies, 1 article on technique development and 2 publications that appeared to relate to the same patients. 20,34,35 Two other groups described technique development, one 36 in dogs and cadavers and the other 37 in dogs and patients. There were 2 reports 21,38 of videoscopic-assisted surgical success in 6 and 39 patients, with a single adenoma.…”

Section: Safetymentioning

confidence: 99%

“…Some groups use an endoscopic approach only, 19,34 and the addition of a QPTH assay has occurred in one such major group. Another technique is to localize the unilateral pathological features, approach through a mini incision, and use a lateral probe to provide "superior visualization" through video assistance.…”

Section: Efficacy Of Minimally Invasive Parathyroidectomymentioning

confidence: 99%