Endoscopic parathyroidectomy: a retrospective review of 27 cases

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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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Affiliations

Authors

Contributions

Dr AB: Chief operating surgeon, manuscript preparation. Dr JG: Collection and analysis of data, manuscript preparation. Dr EA: Manuscript preparation, editing, manuscript approval. Dr RG: Operating team, literature review. Dr GT: Collection and analysis of data. Dr SG: Operating team, literature review. Dr AW: Operating team, image procurement, literature review. Dr CP: Operating team, statistical analysis.

Corresponding author

Correspondence to Ajay Bhandarwar.

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Disclosures

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

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Keywords

  • Endoscopic
  • Parathyroidectomy
  • Endocrine
  • Parathyroid
  • Hyperparathyroidism