Endoscopic parathyroidectomy in primary hyperparathyroidism

Abstract

During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice.

Successful Modified Transoral Endoscopic Parathyroidectomy Vestibular Approach For Secondary Hyperparathyroidism With Ectopic Mediastinal Glands

“…19,20 Endoscopic TPTX through the anterior chest approach, axilla-bilateral chest approach, or robotic surgery were also successfully reported without serious complications for SHPT patients. [21][22][23][24][25] Despite a good surgical outcome, these techniques still leave scars at the incision area.…”

Clinical application of 18F-FCH PET/CT in the diagnosis and treatment of hyperparathyroidism

“…Secondary and tertiary HPT (sHPT and tHPT, respectively) usually require preoperative localization of the parathyroid glands to remove most of the hyperplastic parathyroid tissue ( 2 , 3 ). Several surgical methods are available that vary in terms of the operation time, postoperative pain, and risk of postoperative symptomatic hypocalcemia ( 4 – 6 ); therefore, accurately determining the preoperative location of the parathyroid glands is essential for a successful operation. Parathyroid ultrasound and 99m Tc-methoxyisobutyl isonitrile ( 99m Tc-MIBI) imaging are the first-line diagnostic tests for preoperative localization.…”

Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study)

“…There are two main surgical techniques: unilateral mini-invasive surgery (MIP) and bilateral neck exploration. The results of MIP compared to those of bilateral exploratory surgery show a reduction in post-operative pain, surgery time, and number of symptomatic post-operative hypocalcemia (5)(6)(7). The rate of conversion of MIP to bilateral cervicotomy is estimated at 8-15% (8).…”