Video-assisted neck exploration for primary and secondary hyperparathyroidism - Initial experience

Background: Minimally invasive surgery (MIS) for primary hyperparathyroidis m includes unilateral neck exploration, access via a totally endoscopic app roach, and access via a video-assisted procedure. We report herein our init ial experience with the video-assisted neck exploration procedure for prima ry (PHPT) and secondary hyperparathyroidism (SHPT). Methods: Between June 1999 and May 2000, 35 patients were selected for PHPT (n = 25) and SHPT (n = 10). In all cases, video-assisted neck exploration was performed under general anesthesia, leading to selective adenoma remova l in PHPT or subtotal parathyroid resection in SHPT. Patient selection was based on the preoperative localization studies (ultrasonography and sestami bi scintigraphy). Results: Five of the 25 patients operated on for PHPT (20%) and three of th e 10 patients who underwent surgery for SHPT (30%) were converted to a conv entional surgical technique. The mean operative times in PHPT and SHPT were 48.9 +/- 18.7 min and 136.8 +/- 18.7 min, respectively. The recurrent lary ngeal nerve was identified in 45% of the patients. The median size and weig ht of the resected parathyroid glands were 1.8 cm (range, 0.9-2.5) and 1 g (range, 0.5-7), respectively. The length of skin incision was 24 +/- 1.2 mm . All but one patient are currently cured, with a median follow-up of 6 mon ths (range, 2-13). Postoperative complications included hematoma and transi ent hoarseness in one patient each (2.85%). The median pain intensity, base d on the visual analogue scale (VAS) method, as measured at postoperative d ay 1 was 0.5 (range, 0-3.6). In the PHPT group, the postoperative hospital stay was < 24 h for 30% of the patients and < 48 h for 80% of them. Conclusion: Video-assisted unilateral and bilateral neck exploration is fea sible and safe; it represents an attractive and promising minimally invasiv e approach in PHPT and SHPT when the surgeon follows the same rules used in the standard conventional approach. Its early benefits and long-term resul ts still need to be compared to those of the conventional procedure in a ra ndomized trial.