Minimally invasive video-assisted parathyroidectomy: Lesson learned from 137 cases

Background: Since February 1997, a technique of minimally invasive video-as sisted parathyroidectomy (MIVAP) was developed at our institution for the t reatment of sporadic primary hyperparathyroidism (sPHPT). In this study we analyzed the entire series of patients who underwent MIVAP during the last 3 years. Study Design: One hundred thirty-seven patients with sPHPT were selected fo r MIVAP. Selection criteria were: diagnosis of single adenoma based on preo perative localization studies (ultrasonography, sestamibi scintigraphy, or both), and no previous neck surgery or concomitant large multinodular goite r. The procedure, already described, is performed by a gasless video-assist ed technique through a single 1.5-cm central skin incision above the sterna l notch. Quick, intraoperative parathyroid hormone assay was used in 134 ca ses (97.8%) to confirm the complete removal of all hyperfunctioning parathy roid tissue. Results: Mean operative time was 54.3 +/- 22.6 minutes. The conversion rate was 8.8%. One laryngeal nerve palsy was registered (0.7%), as was one case of persistent hyperparathyroidism. In six patients (4.4%) a transient symp tomatic postoperative hypocalcemia was observed. Two thyroid lobectomies we re associated using the same minimally invasive access. At a mean followup of 15.4 +/- 10.6 months, all but two patients were normocalcemic. The cosme tic result was considered excellent by most of the patients (92.8%). Conclusions: Although not all patients with sPHPT are eligible for MIVAP, t his approach can now be proposed in a bigger proportion (67% of patients). As already demonstrated in a previous study, also in a large series of pati ents, after greater experience has been achieved, the results and the opera tive time are the same as in traditional surgery, with better cosmetic resu lt and a less painful course. (J Am Coll Surg 2000; 191:613-618. (C) 2000 b y the American College of Surgeons).