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Updated: Jul 7, 2026
Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Minimally invasive parathyroidectomy using local anesthesia with intravenous sedation and targeted approaches
Maisie L Shindo1, Joshua M Rosenthal, Thomas Lee
1SUNY at Stony Brook, Stony Brook, NY 11794, USA. maisie.shindo@sunysb.edu
Objectives:
Minimally invasive parathyroidectomy (MIP) is generally performed under general anesthesia. This study evaluates the efficacy and safety of MIP performed under intravenous sedation with local anesthesia.
Study Design:
Historical cohort study.
Subjects:
One hundred eighty-six consecutive patients undergoing MIP using sedation with local anesthesia.
Methods:
Two different targeted approaches were used to achieve good exposure with minimal retraction, which allows the procedure to be performed with little discomfort. In all patients, an adenoma was localized preoperatively and its depth mapped by sestamibi scan with single-photon emission computed tomography and/or ultrasound. A midline anterior approach was used for inferior glands that were superficially located. A lateral approach was used for glands that were located posteriorly or superiorly.
Results:
MIP was successfully completed under local/sedation in 177 patients; 167 were discharged the same day. Complications include two pneumothorax, one small hematoma, and one transient vocal cord paralysis.
Conclusions:
By using a targeted approach, MIP can be safely performed under local anesthesia in appropriately selected patients.
Insights
Minimally invasive parathyroidectomy (MIP) under local anesthesia and sedation is effective and safe. This approach allows for same-day discharge in most patients, improving efficiency in parathyroid surgery.
Area of Science:
- Endocrine Surgery
- Surgical Anesthesia
Background:
- Minimally invasive parathyroidectomy (MIP) is typically performed under general anesthesia.
- Evaluating alternative anesthetic techniques for MIP is crucial for patient outcomes and resource utilization.
Purpose of the Study:
- To assess the efficacy and safety of MIP performed under intravenous sedation with local anesthesia.
- To determine the feasibility of MIP without general anesthesia.
Main Methods:
- Historical cohort study of 186 patients undergoing MIP with local anesthesia and sedation.
- Utilized targeted surgical approaches (midline anterior or lateral) based on preoperative localization (sestamibi scan/SPECT, ultrasound).
- Focused on achieving adequate exposure with minimal retraction for patient comfort.
Main Results:
- Successful completion of MIP under local anesthesia/sedation in 177 patients (95.2%).
- 167 patients (89.8%) were discharged on the same day.
- Reported complications included two pneumothorax, one hematoma, and one transient vocal cord paralysis.
Conclusions:
- MIP can be safely and effectively performed under local anesthesia with sedation in carefully selected patients.
- Targeted surgical approaches enhance the safety and feasibility of MIP under local anesthesia.
- This anesthetic technique offers a viable alternative to general anesthesia for MIP.
