Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India
Keywords:Endoscopic, Parathyroidectomy, Unilateral axilla breast approach, Transoral vestibular
Background: It has been debated that "remote access endoscopic parathyroidectomy" requires extensive dissection, thereby, increasing the risk of complications. Hence, the aim of this study is to assess the feasibility and safety of remote access endoscopic parathyroidectomy via the unilateral axilla-breast approach (ABA) and transoral vestibular approach (TOEPVA).
Method: The study includes 17 patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy from January 2016 to December 2020. Of these, 11 patients underwent parathyroidectomy via unilateral ABA and 6 had TOEPVA. Preoperatively, ultrasonography of neck, sestamibi scan and CT scan neck were done to localise the diseased gland. Post operatively, Serum calcium and parathyroid hormone levels were monitored.
Results: The mean age of patients was 35.6±10.5 years. Except one, all the patients were females. The mean operative time of the unilateral ABA and TOEPVA group was 93.67±28.64 minutes and 138.6±31 minutes respectively. Except for three patients, in all the patients, the parathormone levels normalised. One patient had hungry bone syndrome postoperatively. The mean hospital stay of the unilateral ABA and TOEPVA group was 3±1.5 days and 4±3.09 days respectively. One patient had post-operative transient recurrent laryngeal nerve paresis. Seroma and surgical emphysema were seen in two patients each.
Conclusions: Remote Access Endoscopic parathyroidectomy may be considered safe in treatment of parathyroid tumours. Precise preoperative localisation is mandatory. In addition to a magnified view and a better illumination, the potential advantages of endoscopic techniques are better cosmetic results, decreased hospital stay and better patient comfort.
Toneto MG, Prill S, Debon LM, Furlan FZ, Steffen N. The history of the parathyroid surgery. Rev Col Bras Cir. 2016;43(3):214-22.
Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665-70.
Duh QY. Presidential Address: Minimally invasive endocrine surgery--standard of treatment or hype? Surgery. 2003;134:849-57.
Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253:585-91.
Palazzo FF, Sadler GP. Minimally invasive parathyroidectomy. BMJ. 2004;328:849-50.
Henry JF, Sebag F, Cherenko M. Endoscopic parathyroidectomy: why and when? World J Surg. 2008;32:2509-15.
Bellantone R, Raffaelli M, DE Crea C. Minimallyinvasive parathyroid surgery. Acta Otorhinolaryngol Ital. 2011;31:207-15.
Henry JF, Thakur A. Minimal access surgery-thyroid and parathyroid. Indian J Surg Oncol. 2010;1:200-6.
Gottllieb A, Sprung J, Zheng X-M. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflations. Anesth Analg. 1997;84:1154-6.
Mandl F. Therapeutic attempt for osteitis fibrosa generalisata via the excision of parathyroid tumours. Wien Klin Wochenschr. 1925;38:1343-4.
Pyrtek LJ, Belkin M, Bartus S, Schweizer R. Parathyroid gland exploration with local anesthesia in elderly and high-risk patients. Arch Surg. 1988;123(5):614-7.
Ammori BJ, Madan M, Gopichandran TD. Ultrasound-guided unilateral neck exploration for sporadic primary hyperparathyroidism: is it worthwhile? Ann R Coll Surg England. 1998;80:433-7.
Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clinic North Am. 2000;38:1105-29.
Civelek AC, Ozalp E, Donovan P, Udelsman R. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery. 2002;131:149-57.
Swanson TW, Chan SK, Jones SJ. Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism. Am J Surg. 2010;199:614-20.
Rubello D, Piotto A, Casara D, Muzzio P, Shapiro B, Pelizzo M. Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures Eur J Endocrinol. 2003;149:7-15.
Irvin GL 3rd, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg. 2004;28(12):1287-92.
Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1996;83(6):875.
Ikeda Y, Takami H, Niimi M. Endoscopic total parathyroidectomy by the anterior chest approach for renal hyperparathyroidism. Surg Endosc. 2002;16:320-2.
Ohgami M, Ishii S, Arisawa Y. Scarless endoscopic thyroidectomy: breast approach for best cosmesis. Surg Laparoendosc Percutan Techn. 2000;10:1-4.
Kitano H, Fujimura M, Hirano M. Endoscopic surgery for a parathyroid functioning adenoma resection with the neck region-lifting method. Otolaryngol Head Neck Surg. 2000;123:465-6.
Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc. 2018;32(1):456-65.
Russell JO, Anuwong A, Dionigi G, Inabnet WB 3rd, Kim HY, Randolph G. Transoral Thyroid and Parathyroid Surgery Vestibular Approach: A Framework for Assessment and Safe Exploration. Thyroid. 2018;28(7):825-9.
Sasanakietkul T, Jitpratoom P, Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc. 2017;31(9):3755-63.
Bhargav PRK, Sabaretnam M, Amar V, Devi NV. Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: A South Indian experience. J Minim Access Surg. 2018;15(2):119-23.
Karakas E, Steinfeldt T, Gockel A, Westermann R, Bartsch DK. Transoral parathyroid surgery--feasible! Surg Endosc. 2011;25(5):1703-5
Bhargav PR, Kusumanjali A, Nagaraju R, Amar V. What is the ideal CO2 insufflation pressure for endoscopic thyroidectomy? Personal experience with five cases of goiter. World J Endocr Surg. 2011;3:3-6.