Anterior mediastinotomy for parathyroidectomy

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

“…Complications include pleural effusions, pneumothorax, pneumonia, atrial fibrillation, innominate venous thrombosis and injuries, phrenic and brachial plexus injuries. Sternal wound infection, dehiscence, and non-union (8%), recurrent laryngeal nerve palsies (18.7%), chilous fistula (6.2%), mediastinitis and death from these procedures have been also reported [3,6,14,19,30]. Also in our series, the sternotomic approach showed a trend (although not statistically significant) toward an increased morbidity in respect to other less-invasive approaches.…”

“…Anterior mediastinotomy by parasternal approach (Chamberlain technique) has been also suggested, with an overall success rate of 88.9%, especially for immediately retrosternal and laterally located glands [30]. Nonsurgical options, such as angiographic ablation, has been described for high-risk patients, but the success rate was limited (50%) [3,32]; further disadvantages included serious neurologic complications due to central embolism [3,5] and no tissue availability for pathologic evaluation and for eventual autotransplantation [30].…”

Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations

“…Hemithyroidectomy should be considered for intrathyroidal adenomas or adenomas recurring locally after incomplete resection since simple excision may leave viable parathyroid tissue within the thyroid parenchyma [94]. Anterior low mediastinal glands may be approached by an anterior extrapleural minithoracotomy; adenomas in the aortopulmonary window are best approached by left thoracotomy through the fourth intercostal space [95]. However, thoracoscopic approaches might be preferred because they are less invasive and more comfortable for the patients [96][97][98].…”

Save or sacrifice the internal mammary pedicle during anterior mediastinotomy?

“…If the abnormal gland is successfully removed, the patients’ calcium levels are normalized and patients have same survival rates as the general population. [40] …”