Video-assisted neck surgery (VANS) for primary hyperparathyroidism

Video-assisted neck surgery (VANS) is a minimally invasive surgical technique developed in Japan that offers excellent cosmetic outcomes. This study aims to describe our standardized VANS procedure for primary hyperparathyroidism (PHPT) and to evaluate its safety and surgical outcomes.

We retrospectively reviewed six patients with PHPT who underwent parathyroidectomy using the VANS approach at our institution between January 2022 and December 2024. All patients were diagnosed preoperatively by an endocrinologist. Tumor localization was assessed using computed tomography, ultrasonography, and Tc-99m methoxy-isobutyl-isonitrile scintigraphy. Surgical techniques, operative outcomes, and perioperative complications were evaluated.

VANS was successfully performed in all six patients, including one upper and five lower parathyroid gland lesions. Tumor size ranged from 7 to 23 mm (median, 18 mm). Operative time ranged from 60 to 177 minutes (median, 116.5 minutes), with minimal blood loss. Intraoperative ultrasonography was useful for tumor identification in selected cases. Complete adenoma resection was achieved in all patients without complications or conversion to open surgery.

VANS is a safe, effective, and cosmetically favorable surgical option for selected patients with PHPT. With appropriate patient selection and standardized techniques, this approach can be reproducibly performed in centers experienced in endoscopic neck surgery.