Pre- and intraoperative investigations in video-assisted parathyroidectomy [Tactique et investigations pre-et per-operatoires particulieres a la parathyroidectomie video-assistee]

Video-assisted parathyroidectomy is a new minimally invasive technique. Preoperative localization studies are mandatory and perioperative quick PTH assay is a highly recommended precaution. Patients should be selected on the basis of the following criteria: no evidence of nodular goiter, no previous neck surgery, no history of familial hyperparathyroidism, no suspicion of multiglandular disease. A video-assisted parathyroidectomy by lateral approach was performed in 44 patients with sporadic primary hyperparathyroidism. Among the 46 enlarged glands (2 double adenomas), 42 (91%) were correctly identified by endoscopic exploration. The mean weight of adenomas was 1110 mg (100 mg-6.5 g). The mean operative time was 71 minutes (25'-130). Conversion to transverse cervicotomy was required in 7 patients (16 %). Morbidity was represented by two superficial hematomas in the sterno- cleido-mastoid muscle. All of the 44 patients are biochemically cured, follow up ranging from 3 to 20 months. Video-assisted parathyroidectomy is a feasible, safe and effective procedure. It should have a role in the surgical management of patients with primary sporadic hyperparathyroidism.