Primary Hyperthyroidism. Minimally invasive video-assisted parathyroidectomy
DOI:
https://doi.org/10.31053/1853.0605.v74.n4.15594Keywords:
parathyroidectomy, MIVAP, MIBI, primary hyperparathyroidism, ultrasound.Abstract
Objective. Show our experience performing the minimally invasive video-assisted parathyroidectomy with central approach for the treatment of patients with primary hyperparathyroidism without using intraoperative parathyroid hormone monitoring (IPTHM) based solely on the concordance of two preoperative localization studies.
Material and methods. An informed consent for the accomplishment of a minimally invasive approach was performed on 27 selected patients diagnosed with primary hyperparathyroidism who underwent pre-operative cervical ultrasound and sesta-MIBI scintigraphy studies, which were consistent across them. None had a family history that might indicate a multiple endocrine neoplasia (MEN), known thyroid disease, previous neck incision, or suspicion of carcinoma. Surgery was performed through a 1.5 cm central cervical incision and the use of harmonic scalpel. IPTHM was not performed in either case.
Results. In all cases the topographic location of the adenoma was confirmed. No signs of hyperparathyroidism persistence or recurrence were registered after a follow-up period of 42 months. There were no recurrent nerve lesions. The average operative time was 24.5 minutes and all patients were discharged within 24 hours. The analgesic requirement was minimal and the cosmetic result satisfactory.
Conclusion: The minimally invasive unilateral exploration of the parathyroids with video-assisted magnification without IPTHM, under the guidance of two concordant localization studies is safe and feasible, with comparable results to those of standard technique as well as aesthetic advantages, less postoperative pain and reduced hospitalization.
Downloads
References
- Tibblin S, Bodenson AG, Ljungberg O. Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 1982, 195: 245-252.
- Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996; 83: 875.
- Miccoli P, Materazzi G. Cirugía cervical endoscópica. CirEsp 2005; 77: 181-186.
- Henry JF, Defechereux T, Gramática L, et al. Minimally invasive videoscopicparathyroidectomy by lateral approach.Langenbecks Arch Surg 1999; 384: 298-301.
- Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axilary approach. J am CollSurh 2000; 191: 336-340.
- Henry JF, Jacobone M, Mirallie M, et al. Indications and results of video assisted parathyroidectomy by a lateral approach in patients with a primary hyperparathyroidism. Surgery 2001; 130: 999-1004.
- Berti P, Materazzi G, Miccoli P, et al. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003; 90: 743-747.
- Duh QY. Presidential address: minimally invasive endocrine surgery –Standard of treatment or hype? Surgery 2003;134:849-57.
- Agarwal G, Barraclough BH, Robinson BG, et al. Minimally invasive parathyroidectomy using the ‘focused’ lateral approach. Results of the first 100 consecutive cases.ANZ J Surg2002; 72: 100–104.
- Bergenfelz A, Lindblom P, Tibblin S, et al. Unilateral versusbilateral neck exploration for primary hyperparathyroidism: A prospective randomized controlled trial. Ann Surg 2002; 236: 543–551.
- Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002; 5:665-672.
- Guerrero M, Clark O. A comprehensive review of intraoperative parathyroid hormone monitoring.WJOES 2010; 2: 21-27.
- Henry JF, Misso C, Sebag F, et al. laparatiroidectomia mini-invasiva video-assistita con approcciolateraleneipazienti con iperparatiroidismo primario. Ann ItalChir 2003; 74: 401-405.
- Lombardi CP, Raffaelli M, Traini E, et al. Advantages of a video-assisted approach to parathyroidectomy. ORL J OtorhinolaryngolRelat Spec 2008; 70: 313-318.
- Suliburk JW, Sywak MS, Delbridge LW et al. 1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned. ANZ J Surg 2011; 81: 362–365.
- Gawande AA, et al. Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg 2006; 141: 381-384.
- Mihai R, Palazzo F, Gleeson F, Sadler G. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patiens with primary hyperparathyroidism. Br J Surg 2007, 94: 42-47.
- Perrier ND, et al. Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 2000; 24: 1319-1322.
- Chen H, et al. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery 2005; 138: 583-587. 6.
- Stalberg P, et al. Intraoperative parathyroid hormone measurement during minimally invasive parathyroidectomy: Does it “value-add” to decision-making? J Am CollSurg 2006; 203: 1- 6.
- Miccoli P, Berti P, Materazzi G, et al. Results of video-assisted parathyroidectomy: single institution`s six year experience. World J Surg 2004, 28: 1216-1218.
- Miccoli P, Berti P, Materazzi G, et al. Minimally invasive video-assisted thyroidectomy: Five years of experience. J Am CollSurg 2004; 199: 243-248.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
The Faculty of Medical Sciences Journal (RFCM) subscribes to the Open Access policy and does not charge authors fees for publishing, nor does it charge readers fees for accessing published articles (APC).
