Endoscopically assisted, minimally invasive parathyroidectomy

Background: Despite the success of open parathyroid exploration, minimally invasive alternatives have been emerging. This study reports an experience with endoscopically assisted, minimally invasive parathyroidectomy and eval uates its current role in patients undergoing surgery for hyperpara- thyroi dism. Methods: One hundred consecutive patients requiring surgery for hyperparath yroidism were evaluated. Endoscopic parathyroidectomy was offered based on the absence of coexisting nodular thyroid disease, previous neck surgery or irradiation, suspicion of parathyroid hyperplasia, or other anatomical or medical contraindications. Some 24 of 100 patients fulfilled the criteria a nd underwent endoscopic parathyroidectomy. Unequivocal localization to a si ngle site by a technetium-99m-radiolabelled sestamibi scan allowed removal of the adenoma through a 25-mm suprasternal incision while being guided by a surgical telescope. Results: There were no statistically significant differences in operating t ime or the mean size of resected adenomas between patients undergoing endos copic and open parathyroidectomy. Four patients required conversion to an o pen procedure. Two patients developed temporary recurrent laryngeal nerve p aresis and one had persistent hyperparathyroidism. Conclusion: Although endoscopic parathyroidectomy is technically feasible, its applicability is limited to a minority of patients undergoing operation for hyperparathyroidism. The potential for higher complication and failure rates makes optimism for the procedure appropriately guarded.