Minimally invasive video-assisted parathyroidectomy.

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Standard parathyroidectomy involves bilateral exploration of all four glands.
• Preoperative localization and intraoperative intact parathyroid hormone (iPTH) monitoring enable minimally invasive parathyroidectomy for single adenomas.

Purpose of the Study:

• To evaluate the efficacy of minimally invasive video-assisted parathyroidectomy using intraoperative iPTH monitoring for primary hyperthyroidism.
• To assess the accuracy of preoperative imaging in identifying single versus multiple parathyroid gland disease.

Main Methods:

• Patients with primary hyperthyroidism and a single enlarged gland (confirmed by ultrasound and 99mTc-SestaMIBI scintigraphy) underwent minimally invasive video-assisted parathyroidectomy.
• Intraoperative iPTH levels were measured before and after adenoma excision.
• Successful surgery was defined as a >50% decrease in iPTH levels within 5 minutes post-excision.

Main Results:

• Ten of 22 patients were eligible and underwent successful adenoma removal.
• Two cases showed insufficient iPTH decrease, revealing double adenoma or hyperplasia upon further exploration.
• Preoperative imaging could not entirely rule out multiple glandular disease.

Conclusions:

• Intraoperative iPTH monitoring is essential for minimally invasive parathyroidectomy to confirm operative success and detect multiple glandular disease.
• Minimally invasive parathyroidectomy is a viable alternative to conventional surgery in selected primary hyperthyroidism cases.
• High-resolution ultrasound and 99mTc-SestaMIBI scintigraphy are valuable but not foolproof in diagnosing single gland disease.