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.