Minimally invasive video assisted parathyroidectomy (MIVAP)

The first endoscopic approach to parathyroid glands was reported by M. Gagner in 1996. Later, different accesses have been described using either CO(2) insufflation or external retraction. Other widespread procedures include the lateral access proposed by J.F. Henry and the central gas-less access proposed by P. Miccoli. We hereby describe this central access which allows a bilateral exploration of the neck when necessary. Our patient data base consists of 270 patients operated on since February 1997. The mean age was 56.5 years (20-87 years). The female to male ratio was 4:1. The mean operative time of the procedure was 41.1 min (range 15-180 min). In 13 cases, a video-associated thyroid resection was accomplished during the same operation for associated diseases. Conversion to traditional cervicotomy was required in 20 patients (8.09%). One laryngeal nerve palsy was confirmed 6 months after surgery. We registered one postoperative bleeding, which required us to reoperate on the patient 2 hours after first surgery. The mean operative time and complication rate clearly demonstrate that this approach, like other minimally invasive techniques, can successfully rival the results of traditional surgery for the treatment of primary hyperparathyroidism.