Video-endoscopic approach for parathyroidectomy: results of a prospective study including 100 patients.

Study aim: The aim of this prospective study was to report the results of 1 00 consecutive video-endoscopic parathyroidectomies in patients suspected o f having a single adenoma. Patients and method: From March 1997 to September 2000, 80 females and 20 m ales (mean age: 49.5 years) were operated on. They were selected on the bas is of the following criteria: preoperative imaging in favour of a single ad enoma, absence of goiter and no prior neck dissection. The technique requir ed three trocars; one 5 mm trocar inserted through the middle line of the n eck for the 0-degree 5 mm endoscope, and two 3 mm trocars inserted laterall y in order to perform a bilateral exploration. The neck was inflated to 10 mm Hg pressure with a low flow (3 L/min). Results: Exploration was unilateral, bilateral and interrupted respectively in 52, 45 and 3% of the cases. The reasons for stopping were: an incidenta lly discovered thyroid carcinoma; moderate bleeding occurring from an anter ior jugular vein after introduction of a lateral trocar; and a too-short ne ck. Parathyroid abnormalities were found in 86% of the patients (84 single adenomas, one double adenoma, one hyperplasia of the four glands). In 14% o f the cases, the exploration was unsuccessful. A horizontal cervicotomy was required in 15% of the cases (14 negative explorations and one hyperplasia of the four glands). No intraoperative or postoperative complications occu rred. The mean hospital stay was 24 hours. After 3-month follow-up, the ser um calcium level was normal in 96% of the cases and cosmetic results were e xcellent. Conclusion: A video-endoscopic approach for parathyroidectomy is feasible a nd safe. With sufficient experience, a bilateral and complete exploration o f the neck is possible. Therefore this technique represents a good alternat ive to the traditional cervicotomy in patients with uniglandular disease. ( C) 2001 Editions scientifiques et medicales Elsevier SAS.