Resección toracoscopia de una glándula paratiroidea hipersecretante mediastina

Abstract

In general experienced hands, the inferior parathyroid glands, localized in the thymus or low extrathyrnus are the malo cause or surgical therapeutic fallure. When they could not be approached through cervicotomy, or when they were diagnosed after surgery the sternotoxny or the angiographic ablation were chosen as treatment. The limited number of thoracoscopic approach whit good results published so far, moved us to use this inethod. Material and method: patient of 49 years with a 7 year secondary hiperprathyroidism due to CRI. After a sub total parathyroidectomy with bilateral thimectomy, the patient did not present clinical or laboratory irnprovement. Through a thoracic centellogram sixth MIBI, NMR and CAT, a tumor In the rniddle mediastinurn was fond. The mediastinal structures have been easlly Iclentified through a left thoracoscopic approach. At the level of the aortopulmonary winclow, a turnoral mass is located and, with a simple dissection, et is easily extracted in bag. The biopsy through freezlng conflrms the parathyroid etiolo, of the gland. Result: clinical and laboratory evolution has been favorable, with hospital discharged at the 3- day, and being asyrnptomatic after two years. Conclusion: the hipersecretant parathyroid glands, located in middle mediastinum, that can not be approach through cervicotorny, can he successfully approach through thoracoscopic technique