Video-Assisted Bilateral Neck Exploration in Patients with Primary Hyperparathyroidism and Failed Localization Studies

• Published in: World journal of surgery Vol. 34; no. 10; pp. 2344 - 2349
• Main Authors: Alesina, Pier F., Singaporewalla, Reyaz M., Walz, Martin K.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2010; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Bilateral Neck Exploration; Biological and medical sciences; Cardiac Surgery; Endocrinopathies; Enlarge Gland; Feasibility Studies; Female; General aspects; General Surgery; Humans; Hyperparathyroidism, Primary - surgery; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neck - surgery; Nodular Goiter; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Gland; Parathyroid Hormone - analysis; Parathyroidectomy - methods; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Recurrent Laryngeal Nerve Palsy; Surgery; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Video-Assisted Surgery; Recurrent Laryngeal Nerve Palsy; Parathyroid Gland; Enlarge Gland; Nodular Goiter; Bilateral Neck Exploration; Endocrinopathy; Human; Bilateral; Exploration; Patient; Video recording; Medicine; Treatment; Parathyroid diseases; Surgery; Primary; Neck; Localization; Failure; Hyperparathyroidism
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0700-4

Background In primary hyperparathyroidism (pHPT) positive preoperative localization studies are accepted as a precondition for applying minimally invasive surgical techniques. Without localization, open bilateral neck exploration (BNE) is considered the standard option. Thepresent study analyzes the feasibility and effectiveness of minimally invasive video-assisted BNE in patients with pHPT and negative or discordant localization studies. Methods From a prospective series of 380 minimally invasive video-assisted parathyroidectomies (MIVAP) performed in 367 patients for pHPT (1999–2009), 68 patients (10 male, 58 female; mean age: 58 years) were selected. These patients had failed localization studies and underwent BNE with the MIVAP technique. Operative time, complications, conversions to open technique, and cure rate were determined. Results Mean operative time was 52 ± 26 min (range: 20–180 min). MIVAP with BNE was successfully completed in 66 (97%) patients with two conversions to open technique. Recurrent laryngeal nerve palsy occurred in one patient. Biochemical cure was achieved in 67 patients (98.5%), in 65 patients (95.5%) after the first operation and in two more patients by video-assisted re-exploration on the first postoperative day. One patient remained with persistent disease even after repeated open BNE. Conclusions In experienced hands, video-assisted BNE with the MIVAP technique, for pHPT and failed localization studies, is feasible, safe, and gives results equivalent to the conventional open technique.