Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging

Abstract

Objective: To present first-line thoracic surgery made possible by localization studies in three patients with ectopic parathyroid adenomas. Design and methods: Three patients with ectopic parathyroid tissue in the mediastinum were examined by ultrasound, technetium-99m sestamibi scintigraphy, computed tomography (CT), and venous catheterization with measurement of parathyroid hormone. Without previous cervical exploration, video-assisted thoracic surgery (VATS) was used in all cases to avoid the need for thoracic open surgical procedures. Results and conclusions: The mediastinal parathyroid glands were all detected at scintigraphy, and CT and venous catheterization were helpful in anatomic and functioning characterization. All pathologic glands were successfully resected, with only one minor complication. VATS can safely remove a deep mediastinal parathyroid adenoma and avoid more aggressive open approaches. In an experienced referral center, systematic and sophisticated imaging studies may accurately identify and localize rare ectopic parathyroid adenomas, and avoid cervical surgery.

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

“…Furthermore, thoracoscopy can achieve an additional advantage in case of reoperation, because it does not interfere with other previous approaches; it can be performed through an area not touched in previous surgery, lowering the risk of recurrent nerve injury and hypoparathyroidism [6]. Thoracoscopy has been suggested as the technique of choice for ectopic glands located to the middle and lower mediastinal regions; some limitations have been reported in case of immediately retrosternal parathyroids in the upper part of the anterior mediastinum, with an increased risk of convertion [3,6,8,22,23]. However, thoracoscopic approach may be laborious; it requires single-lung ventilation, pleural incision, and cannot be safely performed in patients with compromised pulmonary function or chest adhesions [20,21].…”

“…In the recent years, following the increased accuracy of preoperative localization studies and the availability of video-assisted techniques, alternative minimally invasive techniques such as mediastinoscopic or thoracoscopic exploration have been proposed [3,8,13,[21][22][23].…”

Combined transcervical and thoracoscopic mediastinal parathyroid adenoma resection

“…6 Tc-99m-sestamibi scintigraphy is considered the gold standard for localization, with sensitivity of 70%-80%. 7,8 Parathyroidectomy is the only curative treatment for primary hyperparathyroidism. Most tumors at the cervical-thoracic junction can be excised by a cervical approach, but difficulty arises with those extending deep into the mediastinum, as in our case.…”

Anterior Mediasten Yerleşimli Ektopik Paratiroid Adenomuna Bağlı Primer Hiperparatiroidizm Olgusu

“…Ancak 2 cm'den küçük nodüller eksplorasyonda bulunamadığı durumlarda, intraoperatif gamma probe ile cerrahi rezeksiyon sağlanabilir (9). Cerrahi ile ilgili bir başka önemli nokta, özellikle anterior veya posterior yerleşimli lezyonlar için video yardımlı torakoskopik cerrahinin (VATS) bir başka alternatif olabileceğidir (10). Son yıllarda literatürde paratiroid adenomları için cerrahi dışı tedavi olarak, alkol ve sklerozan ajanlar ile adenom ablasyonu yapılabilmekte ve etkili sonuçlar alındığından bahsedilmektedir (11).…”