Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy

Miccoli, Paolo; Barellini, Leonardo; Monchik, Jack M.; Rago, Rocco; Berti, Piero

doi:10.1002/bjs.5048

Cited by 47 publications

(33 citation statements)

References 19 publications

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“…Its low invasiveness and the similarity with the conventional procedure render this approach feasible also under locoregional anesthesia (cervical block) [30,31] , at least in selected patients, with the benefit of avoiding the major side effects of general anesthesia. Moreover, it has been demonstrated that locoregional anesthesia allows for a significant reduction of operating room occupation time and it is associated with significantly less postoperative pain [31] .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it has been demonstrated that locoregional anesthesia allows for a significant reduction of operating room occupation time and it is associated with significantly less postoperative pain [31] . As for other targeted approaches, it could be performed as an outpatient and/or same day procedure, at least in selected cases.…”

Section: Discussionmentioning

confidence: 99%

“…The patient, under general or locoregional anesthesia with cervical block [30,31] , is positioned supine with the neck in slight extension. A small (1.5-cm) horizontal skin incision is performed between the cricoid cartilage and the sternal notch, in the midline.…”

Section: Operative Techniquementioning

confidence: 99%

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Advantages of a Video-Assisted Approach to Parathyroidectomy

Lombardi

Raffaelli²,

Traini³

et al. 2008

ORL

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In recent years the advances in preoperative localization studies, the availability of intraoperative parathyroid hormone (PTH) assay and the introduction of cervicoscopy revolutionized the surgical treatment of primary hyperparathyroidism (PHPT). Several endoscopic and video-assisted techniques for parathyroidectomy have been described. In spite of the enthusiasm manifested by some authors, the role of these techniques with respect to the time-honored conventional surgery have been largely debated. Among them, video-assisted parathyroidectomy (VAP) has emerged as one of the leading and more diffuse techniques. To date many large and comparative studies have shown that VAP is an efficacious and feasible procedure with the same complication rate as conventional surgery. Moreover, VAP seems to have significant advantages in terms of cosmetic results, postoperative pain, recovery, and patient satisfaction. When compared with other minimally invasive techniques, it offers the significant advantages of being more similar to conventional surgery and reproducible in different surgical settings. Moreover, it permits bilateral neck exploration, associated thyroid resections and can be performed under locoregional anesthesia. All these characteristics and the excellent results obtained render VAP a valid and well-validated, and even preferable, alternative to conventional surgery for the surgical treatment of sporadic PHPT, especially in case of suspected single adenoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Advantages of a Video-Assisted Approach to Parathyroidectomy

Lombardi

Raffaelli²,

Traini³

et al. 2008

ORL

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“…In the latter method, a deep bilateral cervical plexus block is required with anesthetic infiltration of the wound area [13,14] . The patient lies in a supine position with his neck not hyperextended.…”

Section: Techniquementioning

confidence: 99%

Perspectives and Lessons Learned after a Decade of Minimally Invasive Video-Assisted Thyroidectomy

Miccoli

Berti

Ambrosini³

2008

ORL

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Minimally invasive video-assisted thyroidectomy (MIVAT) was introduced in our department in 1998. The procedure is based on a unique incision in the central neck, 2 cm above the sternal notch, using small conventional retractors and 2-mm reusable instruments. Hemostasis is achieved by using a Harmonic scalpel. 1,320 (1,136 female and 184 male, ratio 4:1) patients have undergone MIVAT since June 1998. Lobectomy was carried out in 421 patients, while 899 patients underwent total thyroidectomy. In 21 cases (RET oncogene mutation carriers), MIVAT was associated with central compartment lymph node clearance. Mean operative time of lobectomy was 32.3 min (range 20–120 min); for total thyroidectomy it was 44.1 min (range 30–130). Mean time for video-assisted central compartment lymphadenectomy was 57 min. Conversion to standard cervicotomy was required in 30 cases (2.2%); operative complications included transient unilateral recurrent nerve palsy in 35 cases (2.65%) and definitive unilateral recurrent nerve palsy in 15 cases (1.13%). Thirty-eight patients exhibited hypoparathyroidism, which corresponds to 4.2% of total thyroidectomies performed, but only 2 showed permanent hypoparathyroidism. MIVAT can be considered a safe operation offering significant cosmetic advantages and has possible new promising indications such as prophylactic thyroidectomy in RET gene mutation carriers.

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“…Nevertheless, with the variable number and anatomic location of parathyroid glands, preoperative imaging has rarely been used for traditional open-neck surgery [8][9][10][11]. Since 90 % of patients with PHPT have a single gland adenoma, minimally invasive parathyroidectomy (MIP) was introduced [12][13][14], with decreased intraoperative time, size of surgical incision and complication rates [15,16]. Accurate preoperative localisation of parathyroid disease is absolutely critical for effective surgical treatment when MIP is used [17,18], and almost all authors also recommend intraoperative PTH hormone level monitoring [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

et al. 2015

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Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy

Abstract: MIVAP performed under RA was associated with a shorter overall operating time and a reduced need for postoperative pain relief.

Cited by 47 publications

References 19 publications

Advantages of a Video-Assisted Approach to Parathyroidectomy

Advantages of a Video-Assisted Approach to Parathyroidectomy

Perspectives and Lessons Learned after a Decade of Minimally Invasive Video-Assisted Thyroidectomy

MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

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