Primary hyperparathyroidism is a common endocrine disorder with adenomas being the most frequent cause. The condition is conventionally treated by a bilateral neck exploration through a cervical incision with removal of the affected glands. Intra-operative parathyroid hormone (IOPTH) monitoring and pre-operative Tc99m MIBI scans are facilitating focused approaches like minimally invasive video-assisted parathyroidectomy (MiVAP) and totally endoscopic parathyroidectomy (TOEP).
Patients with primary hyperparathyroidism were tested for location of diseased gland and accordingly selected for endoscopic parathyroidectomy by either trans-vestibular or trans-axillary approach. Those having undergone prior neck surgery or irradiation and those with an enlarged thyroid were excluded. All patients underwent IOPTH measurement to confirm the completeness of diseased gland resection.
Eleven cases meeting selection criteria underwent endoscopic trans-vestibular parathyroidectomy and 16 cases underwent endoscopic trans-axillary parathyroidectomy. The mean operative time and blood loss were 104 min and 34 mL in trans-vestibular approach, respectively, while they were 47 min and 68 mL for the trans-axillary approach. All patients had post-operative resolution of hypercalcaemia. A single conversion to cervical approach was performed due to unsatisfactory IOPTH fall. A single patient suffered transient recurrent laryngeal nerve palsy which resolved with steroids.
Endoscopic parathyroidectomy is a safe and feasible surgical procedure when combined with pre-operative imaging and intra-operative parathyroid hormone monitoring. There is a steady rise in the number of patients with primary hyperparathyroidism, a majority of whom have solitary gland affliction. Focused exploration is the current standard, wherein endoscopic surgery can be an important tool to improve outcomes.
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Brunaud L, Van Slycke S, Van Den Heede K, Cuny T, Li Z (2016) Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg 5(3):352–360. https://doi.org/10.21037/gs.2016.01.06
Bellantone R, Raffaelli M, De Crea C, Traini ELC (2011) Minimally-invasive parathyroid surgery. Acta Otorhinolaryngol Ital 31:207–215
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875
Sasanakietkul T, Jitpratoom P, Anuwong A (2017) Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc 31(9):3755–3763. https://doi.org/10.1007/s00464-016-5397-5
Kitano H, Fujimara M, Hirano M (2000) Endoscopic surgery for a parathyroid functioning adenoma resection with neck region lifting method. Otolaryngol Head Neck Surg 123(4):465–466. https://doi.org/10.1067/mhn.2000.1015183
Ikeda Y, Takami H, Sasaki Y (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340
Yu H, Bae I, Yi J (2019) The application of subcapsular saline injection during bilateral axillo-breast approach robotic thyroidectomy: a preliminary report. Surg Today 49(5):420–426. https://doi.org/10.1007/s00595-018-1748-2
Yu H, Chung J, Yi J (2017) Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy. Surg Endosc 31(7):3020–3027. https://doi.org/10.1007/s00464-016-5330-y
Lee K, Rao J, Youn Y (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19(3):e71–e75. https://doi.org/10.1097/SLE.0b013e3181a4ccae
Silaghi H, Valea A, Ghervan C, Silaghi AC (2011) Ectopic intrathyroid parathyroid adenoma: diagnostic and therapeutic challenges due to multiple osteolytic lesions. Case report. Med Ultrason 13(3):241–244
Ng P, Lenzo N, McCarthy M, Thompson I, Leedman P (2003) Ectopic parathyroid adenoma localised with sestamibi SPECT and image-fused computed tomography. Med J Aust 179(9):485–487
Caravaiho J, Balingit AG, Shriver CD, Koops MK (2012) Localization of an ectopic parathyroid adenoma by double-phase technetium 99m-sestamibi scintigraphy. Internet J Nucl Med 3(2):1840–1842
Muthukrishnan J, Verma A, Modi KD, Kumaresan K, Jha S (2007) Ectopic parathyroid adenoma—the hidden culprit. J Assoc Phys India 55(JULY):515–518
Yetkin G, Uludag M, Kebudi A, Akgun I, Atay M, Isgor A (2014) Supernumerary ectopic parathyroid glands: Persistent hyperparathyroidism due to mediastinal parathyroid adenoma localized by preoperative single photon emission computed tomography and intraoperative gamma probe application. Hormones 8(2):144–149
Miccoli P, Berti PMG (2008) Endoscopic bilateral neck exploration versus quick intra-operative parathormone assay (qPTHa) during endoscopic parathyroidectomy: a prospective randomized trial. Surg Endosc 22:398–400
Chowbey PK, Soni V, Khullar R, Sharma A, Baijal M (2007) Endoscopic neck surgery. J Minim Access Surg 3(200):3–7
Ruggieri M, Straniero A, Pacini FM, Maiuolo A, Mascaro A, Genderini M (2003) Video-assisted surgery of the thyroid diseases. Eur Rev Med Pharmacol Sci 7(4):91–96
Henry JF, Defechereux T, Gramatica L, De Boissezon C (1999) Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbeck’s Arch Surg 384(3):298–301. https://doi.org/10.1007/s004230050207
Henry JF, Defechereux TGL (1999) Endoscopic parathyroidectomy via a lateral neck incision. Ann Chir 53:302–306
Ikeda Y, Takami HNM (2002) Endoscopic total parathyroidectomy by the anterior chest approach for renal hyperparathyroidism. Surg Endosc 16:320–322
Yeung GHNJ (1998) The technique of endoscopic exploration for parathyroid adenoma of the neck. Austr N Z J 68:147–150
Ohgami M, Ishii SAY (2000) Scarless endosocpic thyroidectomy: breast approach for best cosmesis. Surg Laparoendosc Percutan Techn 10:1–4
Witzel K, Hellinger A, Kaminski C, Benhidjeb T (2016) Endoscopic thyroidectomy: the transoral approach. Gland Surg 5(3):336–341. https://doi.org/10.21037/gs.2015.08.04
Chand G, Mishra SK (2016) Transoral endoscopic thyroid surgery through vestibular approach. World J Endocr Surg 8(2):179–182. https://doi.org/10.5005/jp-journals-10002-1187
Saha D (2017) Review article on transoral endoscopic thyroid surgery. Open Access J Surg 2(3):42–44. https://doi.org/10.19080/oajs.2017.02.555590
Gottllieb A, Sprung JZX-M (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflations. Anesth Analg 84:1154–1156
Gagandeep Talwar received the SAGES Go Global award for presenting a preliminary report of this series at SAGES Annual Meeting in Seattle, USA. Ajay Bhandarwar, Jaini Gala, Eham Arora, Raj Gajbhiye, Gagandeep Talwar, Saurabh Gandhi, Amol Wagh and Chintan Patel have no conflict of interest or financial ties to disclose.
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Bhandarwar, A., Gala, J., Arora, E. et al. Endoscopic parathyroidectomy: a retrospective review of 27 cases. Surg Endosc 35, 1288–1295 (2021). https://doi.org/10.1007/s00464-020-07500-z