Minimally invasive video-assisted parathyroidectomy

The first endoscopic approach to parathyroid glands was reported by Gagner in 1996. Since then, different accesses have been described that use either CO2 insufflation or external retraction. Other widespread procedures are the lateral access, proposed by Henry, and the central gasless access, proposed by Paolo Miccoli, called minimally invasive video-assisted parathyroidectomy. Minimally invasive video-assisted parathyroidectomy is characterized by a central unique 1.5 cm incision, 2 fingers above the sternal notch. Operative space is maintained by external retractors and dissection is performed by means of 30° 5-mm endoscope and small needlescopic instruments lake spatula, forceps, and scissors. When adenoma is identified and the inferior laryngeal nerve is under vision, vascular pedicle is sectioned between clips and the gland is retrieved from the wound. The use of a quick parathormone assay will confirm the complete removal of all hyperfunctioning tissue. The central access allows a bilateral exploration of the neck when necessary. Our experience consists of 652 patients operated since 1997 to July 2007. Mean patient age was 55.1 years, there were 547 women and 105 men. Mean operative time was: 30.2 ± 20.1 minutes. Inferior laryngeal nerve permanent injury rate was 0.6%. Mean operative time and complication rate clearly demonstrate that this approach, like other minimally invasive techniques, can successfully rival the results of traditional surgery for the treatment of primary hyperparathyroidism.