Totally endoscopic lateral parathyroidectomy: prospective evaluation of 200 patients. ESES 2010 Vienna presentation

Several new minimally invasive techniques (mini-open, video-assisted, and endoscopic procedures) for parathyroidectomy have been described. However, totally endoscopic lateral approach parathyroidectomy (Henry technique) is not routinely performed.

This is a prospective study of 200 consecutive patients that underwent totally endoscopic lateral parathyroidectomy.

Two hundred of 387 patients (52%) with primary hyperparathyroidism were included. Fifty-six patients (28%) were converted to open parathyroidectomy. Causes for conversion were lack of intraoperative localization (11%), difficult dissection (10%), bleeding (4%), failure of normalization of IOPTH results (2%), and other causes (1%). Gland localization (areas 1 to 2 versus area 3) and CaPTHus score (<3 versus ≥3) were not associated with the risk of conversion. Mean postoperative follow-up was 13 months, and 196 patients (98%) were cured.

Totally endoscopic lateral approach can be proposed in more than half of the patients with good immediate results. Conversion rate remains important and may explain low acceptance rate of this technique.