Video-assisted parathyroidectomy: surgical technique

Background. In recent years video-assisted parathyroidectomy (VAP) has been proposed as an alternative to conventional bilateral exploration for the treatment of sporadic primary hyperparathyroidism (sPHP). Purpose. The authors give a detailed description of the VAP procedure, which they have employed since 1999, emphasizing its technical aspects. Methods. A total of 38 patients underwent surgery via the VAP technique. Selection criteria included sporadic primary hyperparathyroidism (sPHP) caused by a single, small (< 30 mm), preoperatively well localized adenoma, no history of previous neck surgery or irradiation, and the absence of a concomitant large goiter. VAP is performed through a single 1.5-cm skin incision between the cricoid cartilage and the sternal notch. A 5-mm 30° endoscope is used. Special small instruments 2-3 mm in diameter are used for dissection. The steps of the procedure are similar to those of conventional surgery. Bilateral neck exploration and concomitant video-assisted thyroid resections (VAT) are feasible. The quick iPTH assay is used to assess the success of the procedure. Results. No conversion to conventional surgery was required. Bilateral neck exploration was perforemed in 12 cases. Concomitant VAT was performed in 5 cases. There were two cases of persistence of disease related to the presence of a double adenoma. IN both cases the patient underwent re-operation, which had a successful outcome. NO other complication occurred. All patients are currently normocalcemic. Conclusions. VAP is a valid option for the treatment of sPHP, with significant advantages over conventional surgery, especially in terms of cosmetic results and postoperative pain.