Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases

Area of Science:

• Endocrine Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Minimally invasive video-assisted parathyroidectomy (MIVAP) developed in 1997 for sporadic primary hyperparathyroidism (sPHPT).
• Analysis of MIVAP outcomes over a 3-year period.
• Evaluation of MIVAP in a large patient series.

Purpose of the Study:

• To analyze the efficacy and outcomes of MIVAP for sPHPT.
• To assess the feasibility of MIVAP in a broader patient population.
• To compare MIVAP results with traditional parathyroidectomy.

Main Methods:

• 137 patients with sPHPT underwent MIVAP.
• Selection criteria included single adenoma and no prior neck surgery.
• Gasless video-assisted technique with a 1.5-cm incision and intraoperative parathyroid hormone assay used.
• Associated thyroid lobectomies performed in two cases.

Main Results:

• Mean operative time was 54.3 minutes; conversion rate was 8.8%.
• Low complication rates: 0.7% laryngeal nerve palsy, 4.4% transient hypocalcemia.
• High success rate: 92.8% excellent cosmetic results, normocalcemia in all but two patients at follow-up.

Conclusions:

• MIVAP is suitable for a larger proportion of sPHPT patients (67%).
• Achieved experience demonstrates comparable results and operative times to traditional surgery.
• MIVAP offers superior cosmetic results and a less painful postoperative course.