Minimally invasive parathyroidectomy complicated by pneumothoraces: a report of 4 cases

The traditional approach to primary hyperparathyroidism has been a bilateral neck exploration for evaluation of all four parathyroid glands. With the advent of minimally invasive surgery, minimally invasive parathyroidectomy has become a popular approach for the treatment of parathyroid adenomas. Though exceedingly rare, pneumothorax formation is a potential complication following this procedure. In this paper, we report four cases of pneumothorax following minimally invasive parathyroidectomies. The commonality in all these cases was positioning with extreme neck hyperextension. Additional risks in three patients were dissection in the superior mediastinum, traction on the thyrothymic ligament, and a low-lying inferior parathyroid gland. One patient developed a pneumothorax prior to dissection along the superior mediastinum. This suggests that further risk factors may be heat conduction from the electrocautery and total intravenous anesthesia with spontaneously breathing of the patient.