VIDEO-ASSISTED PARATHYROIDECTOMY BY LATERAL APPROACH IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

Abstract

Introduction: Different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy (VAP) in the management of patients with primary hyperparathyroidism (PHPT).

Materials and methods: Between 1998 and 2002, 528 patients were operated on because PHPT. VAP was propo sed for patients with sporadic PHPT, without associated goiter and previous neck surgery, in whom a single adeno ma was localized. VAP was performed by lateral approach with insufflation for patients with adenoma located deeply in the neck and by gasless midline approach for anteriorly located adenomas. A quick parathyroid (qPTH) assay was used during the surgical procedure. Calcemia, phosphoremia and PTH were systematically evaluated after surgery.

Result: Of 528 patients with PHPT, 228 (43%) were not eligible for VAP because associated nodular goiter (99 cases), previous neck surgery (42 cases), suspicion of multiglandu lar disease (25 cases), lack of preoperative localization (48 cases), and miscellaneous causes (14 cases). VAP was perfor med in 300 patients with sporadic PHPT : 282 lateral access, 17 midline access and one thoracoscopy. Mean ope rative time was 50’. Conversion to conventional parathy roidectomy was required in 14% of cases. One patient pre sented a definitive recurrent nerve palsy. One persistent and one recurrent PHPT were observed.

Conclusion: VAP can be proposed for patients with PHPT. Immediate results of VAP are similar to those obtained with conventional parathyroidectomy; no conclusions can be drawn in terms of influence of VAP on the outcome of the patients operated for PHPT