Endoscopic parathyroidectomy via a lateral neck incision.

A new approach to endoscopic parathyroidectomy is proposed. Via a 15 mm tra nsverse incision on the anterior border of the sternocleidomastoid muscle ( SCM), the fascia connecting the lateral portion of the strap muscles and th e thyroid lobe to the carotid sheath is divided at the level of the prevert ebral fascia. Once enough space has been created, three trocars are inserte d: a IZ nun trocar through the incision and two 2.5 mm trocars above and be low the first trocar. Carbon dioxide is insufflated at a pressure of 8 mmHg . Unilateral endoscopic parathyroid exploration is then performed with a 10 mm-0 degrees endoscopic camera. Once the adenoma has been identified and, if possible the ipsilateral parathyroid gland, the 3 trocars are removed an d the adenoma is extracted from the neck after clipping its pedicle directl y through the 15 mm incision. Twenty patients with sporadic primary hyperpa rathyroidism were operated. The adenoma was localized pre-operatively in 14 patients. Intra-operative quick parathyroid hormone assay was used. Explor ation was unilateral in 15 patients - Conversion to transverse cervicotomy was performed in 5 cases. In the 50 explored parathyroid areas, 34 glands ( 68 %) were identified by video surgery : 18 of the 21 enlarged glands (86 % ) and 16 of the 29 normal glands (55 %). Mean operating time was 88 minutes (40'-130'). Morbidity consisted of 2 superficial hematomas in the SCM. Wit h a follow-up ranging from 6 to 15 months, all 20 patients are biochemicall y cured. This study demonstrates that endoscopic parathyroid exploration ca n be performed via a lateral incision.