Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: subxiphoid and lateral thoracic approach

Abstract

Background: This study aimed to investigate the initial results of an endoscopic surgical approach for the treatment of intramediastinal ectopic parathyroid adenoma and to evaluate the effectiveness of a singleincision resection using the subxiphoid approach. Methods: Five cases of patients (1.89%) were diagnosed with ectopic mediastinal parathyroid tumor and underwent resection from 2008 to 2017 in Fujita Health University Hospital. They were retrospectively analyzed. Results: Four patients underwent single-port mediastinal tumor resection using the subxiphoid approach and 1 patient underwent multi-port mediastinal tumor resection using the lateral thoracic approach.The operation time was 134±83.52 min, and the amount of blood loss was 81.8±173.41 mL. The rate of conversion to thoracotomy was 0%, and no intraoperative or postoperative complications were observed.The amount of postoperative oral analgesics was 112.83±209.12 tablets, and their administration period was 561.6±1,229.5 days. The length of hospital stay was 4±2.35 days, and the duration of chest tube drainage was 1.33±1.95 days. The patient who underwent multi-port mediastinal tumor resection using the lateral thoracic approach reported postoperative pain. Serum calcium levels decreased from 10.56±1.52 mg/dL preoperatively to 8.96±0.5 mg/dL postoperatively, and serum phosphorous levels increased from 2.84±0.42 mg/dL preoperatively to 3.6±0.51 mg/dL postoperatively. Intact-PTH hormone levels decreased from 221±169.84 pg/dL preoperatively to 70.2±44.28 pg/dL postoperatively. No recurrence of hyperparathyroidism has been observed in any patient. Conclusions: The single-incision mediastinal tumor resection via the subxiphoid approach, without going through the intercostal space, is considered as a useful endoscopic surgical approach for the treatment of mediastinal ectopic parathyroid adenomas due to the limited occurrence of post-thoracotomy pain syndrome and the superior esthetic outcomes associated with the procedure as compared to thoracotomy and median sternotomy.

Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus

“…For masses located deeper inside the mediastinum, instead of standard open techniques such as thoracotomy, median sternotomy and manubriotomy, minimally invasive approaches are developed as well (video-assisted mediastinal surgery-VAMS [13,17] and VATS [20][21][22][23]. It is considered "first line" treatment option for patients with mediastinal parathyroid adenoma located deeper than the brachiocephalic vein [20].…”

Primary hyperparathyroidism

“…The latest studies showed that single-incision mediastinal tumour resection by subxiphoid access is a useful endoscopic surgical approach for the treatment of mediastinal ectopic parathyroid adenomas. The post-thoracotomy pain syndrome is limited, and the aesthetic outcomes are protreptic [51]. Most patients undergoing VATS do not suffer from serious complications, but some may require conversion to median sternotomy for thymoma removal in cases of false positive pre-operative imaging.…”

Technique for ectopic intrathymic parathyroid adenoma: the uniportal subxiphoid approach

“…Ectopic mediastinal PAs (MEPA), which account for ~1–2% of all PAs, are recognized as major cause for persistent PHPT with severe clinical manifestations [ 5 ]. With surgical MEPA-resection as the only therapeutic option, key points for successful surgical treatment are: (i) an adequate preoperative imaging modality to accurately localize the ectopic PA and (ii) the radical resection of all possible ectopic PA-including mediastinal tissue [ 6 , 7 ]. With modern imaging techniques as essential prerequisite, the uniportal subxiphoid approach is an excellent surgical technique for a complete ectopic mediastinal parathyroidectomy.…”