Endoscopic parathyroidectomy: report of an initial experience

Area of Science:

• Endocrinology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Minimizing surgical extent in primary hyperparathyroidism is crucial.
• Preoperative localization and intraoperative parathyroid hormone (PTH) assays aid in reducing surgical intervention.
• Endoscopic procedures are emerging for parathyroidectomy.

Purpose of the Study:

• To evaluate the feasibility and outcomes of endoscopic parathyroidectomy.
• To assess the effectiveness of a gasless endoscopic approach combined with intraoperative PTH monitoring.
• To compare endoscopic parathyroidectomy with conventional methods.

Main Methods:

• 39 patients with primary hyperparathyroidism underwent endoscopic parathyroidectomy over 13 months.
• Selection criteria included preoperative diagnosis of a single adenoma, no nodular goiter, and no prior neck surgery.
• A gasless unilateral neck exploration with adenoma excision and intraoperative PTH measurements was performed.

Main Results:

• 39 parathyroid adenomas (mean diameter 21 mm) were successfully removed.
• Mean operative time was 65 minutes.
• All patients showed significant PTH decrease, normal postoperative calcium and PTH levels, and experienced less pain compared to conventional surgery.

Conclusions:

• Endoscopic parathyroidectomy is a feasible procedure with acceptable operative times and excellent cosmetic outcomes.
• The gasless approach effectively prevents emphysema.
• This technique offers a safe and effective alternative for selected patients with primary hyperparathyroidism.