Advantages of a video-assisted approach to parathyroidectomy

In recent years the advances in preoperative localization studies, the availability of intraoperative parathyroid hormone (PTH) assay and the introduction of cervicoscopy revolutionized the surgical treatment of primary hyperparathyroidism (PHPT). Several endoscopic and video-assisted techniques for parathyroidectomy have been described. In spite of the enthusiasm manifested by some authors, the role of these techniques with respect to the time-honored conventional surgery have been largely debated. Among them, video-assisted parathyroidectomy (VAP) has emerged as one of the leading and more diffuse techniques. To date many large and comparative studies have shown that VAP is an efficacious and feasible procedure with the same complication rate as conventional surgery. Moreover, VAP seems to have significant advantages in terms of cosmetic results, postoperative pain, recovery, and patient satisfaction. When compared with other minimally invasive techniques, it offers the significant advantages of being more similar to conventional surgery and reproducible in different surgical settings. Moreover, it permits bilateral neck exploration, associated thyroid resections and can be performed under locoregional anesthesia. All these characteristics and the excellent results obtained render VAP a valid and well-validated, and even preferable, alternative to conventional surgery for the surgical treatment of sporadic PHPT, especially in case of suspected single adenoma.