Video-assisted parathyroidectomy: learning curve.

Study aim: Minimally invasive video-assisted parathyroidectomy (MIVAP) was introduced in 1997 for the treatment of sporadic primary hyperparathyroidis m (sPHPT). The study aim was to review the entire series of patients operat ed on in order to analyse the learning curve of this procedure. Patients and methods: Between February 1997 to January 2001, 185 patients u nderwent MIVAP All these patients were divided into three groups: group A ( GA) included 63 patients operated on between February 1997 and September 19 98; group B (GB) 64 patients operated on between October 1998 and January 2 000; Group C (GC) 64 patients operated on between January 2000 and January 2001. Mean operative time, complications and conversions rates of the three groups were compared. Results: The three groups were well matched for age and gender. Mean operat ive time was significantly shorter in patients of GC (28.3 +/- 13.6 min) wh en compared with GA (62.3 +/- 24.6 min) and GB (48.4 +/- 18.1 min). Convers ion was required in 3 cases of GA (4.8%), in 8 cases of GB (12.8%) and in 4 cases of GC (6.5%). One transient postoperative recurrent nerve palsy and 4 cases of transient postoperative hypocalcemia were observed among patient s of GA. No complications were registered in the other groups. Conclusions: This study shows that with increasing experience, the operativ e time of MIVAP was dramatically reduced, as well as postoperative complica tions rate. The higher percentage of conversion in groups B and C may be ex plained by the fact that, with increasing experience, more difficult and am biguous cases were operated with this technique. (C) 2001 Editions scientif iques et medicales Elsevier SAS.