[Primary Hyperthyroidism. Minimally invasive video-assisted parathyroidectomy]

Area of Science:

• Endocrinology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Primary hyperparathyroidism is a common endocrine disorder.
• Minimally invasive parathyroidectomy offers advantages over traditional surgery.
• Intraoperative parathyroid hormone monitoring (IPTHM) is often used but may not always be necessary.

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive video-assisted parathyroidectomy using a central approach.
• To assess the feasibility of performing this procedure without intraoperative parathyroid hormone monitoring (IPTHM).
• To rely solely on concordant preoperative localization studies for surgical guidance.

Main Methods:

• 27 patients with primary hyperparathyroidism underwent minimally invasive parathyroidectomy.
• Preoperative localization utilized cervical ultrasound and sesta-MIBI scintigraphy, with consistent results.
• Surgery involved a 1.5 cm central cervical incision and harmonic scalpel, without IPTHM.

Main Results:

• Successful adenoma localization was achieved in all cases.
• No signs of hyperparathyroidism persistence or recurrence were observed during a 42-month follow-up.
• No recurrent laryngeal nerve injuries occurred, with short operative times and rapid discharge.

Conclusions:

• Minimally invasive parathyroidectomy with video-assisted magnification and a central approach is safe and feasible without IPTHM.
• This technique, guided by concordant localization studies, yields results comparable to standard methods.
• The procedure offers aesthetic benefits, reduced postoperative pain, and shorter hospital stays.