[Videocervicoscopy in surgery of primary hyperparathyroidism. Preliminary study of 19 patients]

The aim of this study was to assess the feasibility of a minimally invasive parathyroidectomy performed by videocervicoscopy. 19 patients were operated. Preoperative localization by ultrasonography and/or technetium 99 m sestamibi scan was performed in 17 patients. The technique was first attempted in two pigs, using three 2.5 mm trocars and a 2.5 mm endoscope. However, this technique failed in the first two human cases because of the lack of optical clarity of the 2.5 mm endoscope. A 5 mm endoscope was subsequently used. Carbon dioxide insufflation was maintained at 10 mmHg with a low 3 L/min flow. Three trocars were inserted in to the cervical space: one 5 mm trocar for the endoscope, two 3 mm trocars for the instruments. A unilateral neck exploration was carried out in 5 cases and a bilateral neck exploration in 14 cases. Enlarged glands were discovered in 13 patients (12 adenomas, 1 hyperplasia of the 4 glands). 8 adenomas were removed via a short midline incision, 4 others via a short lateral incision. Horizontal cervicotomy was required in 7 cases (4 failures to identify the abnormal gland, 1 thyroid cancer discovered incidentally, 1 hyperplasia of 4 glands and 1 anterior jugular vein bleeding). Except for the case of bleeding, no other complication occurred. Subcutaneous emphysema resorbed in 3 hours. 17 patients were discharged within 48 hours and 2 patients were discharged within 24 hours. 18 patients had normal serum calcium two months postoperatively. This study demonstrates that videocervicoscopy is safe and feasible in primary hyperparathyroidism.