Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism

Purpose. The authors report the results of 127 procedures using minimally invasive video-assisted parathyroidectomy (MIVAP) to treat primary hyperparathyroidism over a period of 2 1/2 years, all performed by the same surgeon in a single facility. Methods. All the patients were referred for primary hyperparathyroidism and underwent localization studies prior to surgery. The MIVAP procedure was performed using a gasless video-assisted technique through a single 1.5 central skin incision above the sternal notch. Results. The rate of conversion was 7.1%. Complications included 1 case of recurrent nerve palsy (0.9%) and 1 case of persistent hyperparathyroidism. Anhestesia for the last 16 patients in the series consisted of bilateral superficial block plus the use of a laryngeal mask and sevofluorane instead of general endotracheal anesthesia. In 1 case, two thyroid lobectomies were carried out usig the same minimally invasive access. Conclusion. MIVAP can claim the same results as traditional surgery, offering, in addition, advantage such as better cosmetic result and less postoperative discomfort. The technique is not feasible in all cases of primary hyperparathyroidism, but in the series studied, it was used successfully in more than 70% of the cases.