Thoracoscopic Removal of Hypertrophic Mediastinal Parathyroid Glands in Recurrent Secondary Hyperparathyroidism

Abstract

HMPGs in recurrent SHPT may be multiple. Sestamibi scans combined with CT scans can guide optimal approaches. The thoracoscopic approach provides a safe and feasible technique in retrieving HMPGs in Zones I or II using 3 trocars. For HMPGs in Zone III, they should be handled with care using 4 trocars.

Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study

“…The results of phosphorus were also encouraging, as evidenced by the decreasing tendency after MWA. In general, the success rate in the present study was inferior to the 90-100% of thoracoscopy of the mediastinal parathyroid glands [33][34][35] and 76-95% of open surgery for persistent and recurrent SHPT [30,36]. However, MWA has a shorter operation time, fewer complications, and a wider indication than surgery.…”

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

“…The literature review identified nine English‐language case series consisting of five or more VATS parathyroidectomies, with a combined total of 87 patients ( Table ). PHPT was the most common pathology treated (51 of 69), and 54 per cent of patients (34 of 63) had undergone previous non‐curative neck exploration, consistent with the present patient group.…”

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

“…At the end of follow-up, most patients (80%) had iPTH levels within the range recommended by the recent KDIGO CKD-MBD guidelines [4]. The results were inferior to those of thoracoscopy and open surgery [7][8][9][10]36]; however, MWA has a shorter operation time, fewer complications and wider indications.…”

“…The eligibility criteria for MWA procedure in this study were as follows: (1) a clear history of SHPT and medication intolerance; (2) intact parathyroid hormone (iPTH) levels greater than 800 pg/mL [27] or less than 800 pg/mL but with uncontrolled hypercalcemia; (3) at least one enlarged, possible ectopic SHPT nodule was seen on ultrasound and was accessible to MWA treatment; (4) the needle path was unobstructed by any major blood vessels, nerves or esophagus; (5) radionuclide concentration was seen in the nodules in both early and delay phases of the MIBI scan; (6) no bleeding tendency, i.e., prothrombin time less than 25 s, prothrombin activity higher than 40%, and platelet count greater than 40 cells Â10 9 /L; (7) no serious coexisting complications such as cardiac insufficiency or hypertension. Exclusion criteria included recurrent laryngeal nerve injury after laryngoscopic examination in patients presenting with voice changes.…”

“…The prevalence of ectopic parathyroidism ranges from about 2% and 43% in various anatomical series and 14% and 16% in patients with primary and SHPT, respectively [6]. Traditionally, when the ectopic SHPT was located in the mediastinum, it was treated by mediastinotomy or thoracoscopic approach [7][8][9][10]. The remaining ectopic nodules located in the submandibular region, neck or suprasternal fossa are often refractory to surgical resection [11,12] due to anesthesia risks in SHPT patients with poor health condition and pre-and post-surgical complications [13].…”