THE SUBXIPHOID LAPAROSCOPIC APPROACH FOR RESECTION OF MEDIASTINAL PARATHYROID ADENOMA AFTER SUCCESSFUL LOCALIZATION WITH TC-99M-SESTAMIBI RADIONUCLIDE

Primary hyperparathyroidism is caused by an ectopically located parath yroid adenoma in a small percentage of cases. Parathyroid adenomas loc ated within the retrosternal area of the anterior mediastinum account for a large proportion of failed initial cervical explorations. Curren t surgical approach to these lesions is via median sternotomy, with th e discomfort, hospitalization, and morbidity associated with a major t horacic operation. We report a new technique for the resection of thes e ectopic parathyroid adenomas after successful radiologic localizatio n: a minimally invasive subxiphoid laparoscopic approach. The procedur e was performed in a symptomatic patient with documented primary hyper parathyroidism who had failed three previous neck operations. The ecto pic parathyroid adenoma was successfully resected endoscopically, with resolution of the hypercalcemia. The patient was discharged on the th ird postoperative day, avoiding completely the morbidity of a median s ternotomy.