Endoscopic parathyroidectomy: Report of an initial experience

Background. Preoperative localization of parathyroid lesions and intraopera tive quick parathyroid hormone (PTH) assay have been proposed to minimize t he extent of operation in primary hyperparathyroidism. To this purpose, end oscopic procedures have been introduced recently. Methods. During a period of 13 months, 39 of 65 consecutive patients with p rimary hyperparathyroidism were selected for endoscopic parathyroidectomy o n the basis of the following criteria: preoperative echographic diagnosis o f a single adenoma, absence of nodular goiter; and no prior neck operations . Unilateral neck exploration and excision of the adenoma was performed thr ough a gasless procedure combined with intraoperative PTH measurements, Mea n follow-up after the operation was 7 months (range 1 to 13 months). Results. Thirty-nine parathyroid adenomas were removed; the mean diameter w as 21 mm (range 5 to 30 mm). The mean operative time was 65 minutes (range 30 to 180 minutes). In all cases PTH concentration decreased significantly. Patients who underwent endoscopic parathyroidectomy had less postoperative pain compared with patients who underwent conventional hemithyroidectomy. At follow-up, serum calcium and PTH levels were normal in all cases. Conclusions. Endoscopic parathyroidectomy proved to be a feasible surgical procedure that can be performed in an acceptable operative time with an exc ellent cosmetic result. The gasless approach avoided any emphysema.