VATS parathyroidectomy for primary hyperparathyroidism

Abstract

Mediastinal ectopic parathyroid glands are uncommon. Traditionally, median sternotomies were performed to treat this type of lesion, resulting in a long, painful postoperative period and poor aesthetic results. With the advent of video-assisted thoracoscopic surgery, procedures were performed more frequently by this route with the same surgical and oncological results as those achieved with conventional surgery. The introduction of more sophisticated imaging studies, such as computed tomography, computed tomography–technetium-99m sestamibi scintigraphy, and single-photon emission computed tomography, facilitated identification of the exact location of the lesion. Video-assisted thoracoscopy became a safe approach and the treatment of choice for resection.

Pediatric Neuroendocrine Neoplasia of the Parathyroid Glands: Delving into Primary Hyperparathyroidism

“…Thoracoscopic parathyroidectomies, including those conducted through minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), that are facilitated by having a precise preoperative location of the adenoma, have been safely used in selected adult cases of ectopic or extremely large orthotopic parathyroid tumors; the similar pediatric application also seems safe, according to current knowledge, despite a low level of statistical evidence [11,[80][81][82]. For example, Vitale et al [69] reported, in 2022, the first pediatric case of PHP-associated ectopic (intra-thymic) mediastinal adenoma complicated by bilateral slipped capital femoral epiphysis (the same team analyzed similar, previously published, cases and identified 13 reports with unilateral epiphysis lesions).…”

“…Case reports identified another seven subjects with the same postparathyroidectomy hypocalcemia-based syndrome; a potential connection with ectopic presentation or brown tumors was suggested, but there are limited data from a strictly statistical perspective [15,36,[69][70][71][72]74]. Minimally invasive thoracoscopic approaches seem safe, and they should be used for ectopic tumors when possible [11,[80][81][82].…”