Surgery for primary hyperparathyroidism in 1998 (66 patients, three types of approach)

Study aim: The aim of this prospective study was to assess the advantages a nd disadvantages of cervicotomy, selective lateral approach and video-assis ted surgery in the treatment of primary hyperparathyroidism (HPT 1). Patients and methods: During 1998, 66 patients were operated on for HPT 1 i n the same center. There were 48 women and 18 men (mean age : 58 years, ran ge.21-84), familial HPT 1 or MEN1 excluded. The interventions were performe d via classical cervicotomy (n = 32), via selective lateral approach (n = 8 ) and were video-assisted (n = 25). A mediastinal adenoma was removed via c ervicotomy and another one via left thoracoscopy. The procedure was associa ted with intraoperative parathormone (PTH) quick-assay. Calcium testing was controlled before leaving the hospital and 2 months later. Results: A double adenoma and 65 single adenomas were confirmed by patholog ical report. Circulating PTH levels, 20 minutes after removal of the adenom a, always decreased significantly. In video-assisted procedures, there were 11 conversions to open cervicotomy (44 %) and morbidity consisted of one c ase of laryngeal nerve paralysis. At the end of the study, all patients exc ept one had a normal calcium level. Conclusion: Video-assisted parathyroidectomy is feasible but requires a pre operative localisation of the adenoma and intraoperative PTH quick-assay. I ts main benefit in cervical adenoma is to reduce the scar and in mediastina l adenoma to avoid sternotomy. With the elective approach, results are simi lar to those of video-assisted surgery and the procedure is much easier to perform. Classical cervicotomy is still the best option in case of previous cervicotomy, of simultaneous thyroidectomy, of negative preoperative imagi ng and in elderly patients less concerned about cosmetic benefit. (C) 2000 Editions scientifiques et medicales Elsevier SAS.