Video-assisted parathyroidectomy

Area of Science:

• Surgical Oncology
• Endocrine Surgery
• Minimally Invasive Procedures

Background:

• Parathyroid surgery traditionally involves larger incisions, but advancements in endoscopic instruments have driven the development of minimally invasive techniques.
• Endoscopic parathyroidectomy, while effective, carries risks like emphysema and hypercarbia due to CO2 insufflation.
• Minimally invasive video-assisted parathyroidectomy (MIVAP) emerged as a safer, more flexible alternative with a small incision (1-1.5 cm).

Purpose of the Study:

• To evaluate the efficacy and safety of minimally invasive video-assisted parathyroidectomy (MIVAP).
• To explore the integration of radio-guided techniques with MIVAP for enhanced parathyroid tumor localization.
• To assess the utility of radio-guided techniques in both MIVAP and open parathyroidectomy for complex cases.

Main Methods:

• MIVAP performed using a small cervical incision.
• Preoperative diagnosis using ultrasonography and 99mTc-methoxyisobutylisonitrile (MIBI) scans.
• Development and application of minimally invasive radio-guided and video-assisted parathyroidectomy (MIRVAP) using intraoperative nuclear mapping with a gamma probe after MIBI administration.
• Radio-guided open parathyroidectomy (RGOP) applied in multiglandular disease (MGD) cases.

Main Results:

• MIVAP demonstrated benefits in minimal invasiveness and cosmetic outcomes.
• MIRVAP successfully combined MIVAP with radio-guided localization, facilitating tumor identification.
• Radio-guided techniques proved useful in MIVAP and RGOP, particularly for challenging multiglandular disease cases.

Conclusions:

• MIVAP is a beneficial approach for parathyroid surgery, offering minimal invasiveness and improved cosmesis.
• Radio-guided parathyroidectomy (MIRVAP and RGOP) enhances surgical feasibility and precision.
• Further advancements in instrumentation and MIBI dosage may expand the application of MIRVAP.