Thoracoscopic removal of hypertrophic mediastinal parathyroid glands in recurrent secondary hyperparathyroidism

Hypertrophic mediastinal parathyroid glands (HMPGs) play a role in recurrent secondary hyperparathyroidism (SHPT). Thoracoscopic retrieval of HMPGs has been proposed.

Twelve patients with recurrent SHPT owing to HMPGs were enrolled. We divided the locations of HMPGs below the innominate vein and right to the ascending aorta as Zone I, those below the innominate vein and left to the ascending aorta as Zone II, and those between the aortic arch and pulmonary artery as Zone III. Sestamibi scans combined with computed tomography (CT) scans were arranged to identify the location of HMPGs. Three trocars of the right or left thoracoscopic approach were applied for Zone I or Zone II; four trocars of the left thoracoscopic approach were applied for Zone III.

Sestamibi and CT scans could positively find the 15 parathyroid glands of the 12 patients. Thirteen HMPGs were retrieved successfully with a thoracoscopic approach. The mean operation time was 155 min (range 80-292) and the mean hospital stay was 5.9 days (4-8). After a mean follow-up of 29.6 months (3-61), calcium and intact parathyroid hormone levels returned to normal ranges in all patients except for one who preferred two-stage surgery. Neither perioperative mortality, nor major complications occurred.

HMPGs in recurrent SHPT may be multiple. Sestamibi scans combined with CT scans can guide optimal approaches. The thoracoscopic approach provides a safe and feasible technique in retrieving HMPGs in Zones I or II using 3 trocars. For HMPGs in Zone III, they should be handled with care using 4 trocars.