Minimally Invasive Video-Assisted Parathyroidectomy

Abstract

Many different minimally invasive procedures have been proposed for the surgical treatment of primary hyperparathyroidism (pHPT). The “pure” endoscopic approach [1, 2] was the first operation presented by M. Gagner in 1996 and it was characterized by a steady gas flow insufflated at low pressure. Other approaches were then introduced, ranging from video-assisted gasless techniques [3, 4] to open minimally invasive parathyroidectomy (OMIP) either guided by an intraoperative scan [5] or just relying on preoperative localization studies [6, 7]. In 1997, we reported on a personal technique [4, 8] named minimally invasive video-assisted parathyroidectomy (MIVAP) that has been adopted by several centers during the last years [8–11]. In spite of the favor encountered by these operations among the patients, many endocrine surgeons are still reluctant to accept these minimally invasive procedures because they might be too time consuming, too expensive and not viable for all the patients presenting pHPT. With regard to this last point, it is of paramount importance to define very carefully the exact indications to this minimally invasive surgery.