Minimally invasive video-assisted parathyroidectomy. Initial experience in a General Surgery Department

Background: The aim of this study is to analyze our preliminary results from minimally invasive video-assisted parathyroidectomy (MIVAP) and demonstrate the feasibility of MIVAP also in non-referral centers. Material and methods: During a period from June 2005 to January 2008, in the General Surgery Department of University of Trieste, we operated on 39 patients with primary hyperparathyroidism (pHPT). MIVAP by an anterior approach was proposed for 23 (59%) patients with sporadic pHPT and one unequivocally enlarged parathyroid gland on pre-operative ultrasound and 99mTc-SestaMIBI scintigraphy without associated goiter and without previous neck surgery. Intra-operatively, a quick parathyroid assay was used during the last 11 surgical procedures. All patients underwent pre-operative and post-operative investigations of calcemia, phoshoremia and PTH levels and vocal cord function. Age, operative times, pathologic findings, post-operative pain, calcemia, length of hospital stay, cosmetic results, and complications were retrospectively analyzed. Results: MIVAP was successfully accomplished in 22 cases. Conversion to standard cervicotomy was required in one patient (4.34%). Mean operative time was 67 min. Post-operative complications included 1 (4.34%) transient hypocalcemia. No laryngeal nerve palsies, no definitive hypocalcemias, no persistent pHPT and no recurrent pHPT were observed. The cosmetic result was excellent in all cases. Conclusions: Our preliminary results demonstrate that MIVAP for localized single-gland adenoma, after adequate training, seems to be feasible with significant advantages, especially in terms of cosmetic results, post-operative pain, and post-operative recovery even in a General Surgery Department, if performed by a dedicated team, with a sufficient and specific activity volume

Scandinavian quality register for thyroid and parathyroid surgery: audit of surgery for primary hyperparathyroidism.

Background and aim Scandinavian Quality Register for Thyroid and Parathyroid Surgery is an on-line web-based database with the aim to improve the quality of thyroid and parathyroid surgery. Preliminary data from surgery for primary hyperparathyroidism are reported here. Materials and methods Fifteen departments registered 806 operations, with 639 women (79.7%) and 167 men. The median age of the patients was 62 years. Results Approximately 95.4% of the patients had sporadic disease and first time operation was performed in 93.8% of the patients. Localization examinations were performed in 524 patients (65%); sestamibi scintigraphy in 413 patients, with a true positive adenoma localization in 64.4% and ultrasound in 293 patients with adenoma localization in 61.1%. Bilateral neck exploration was performed in 66.8%, unilateral exploration in 16.1%, and focused minimal invasive surgery in 17.1%. In 301 patients planned for limited parathyroid exploration, conversion to bilateral neck surgery occurred in 11%. The cure rate, based on short follow-up, was 91.9%. Postoperative hypocalcemia occurred in 11.4% of the patients, and was associated with reoperation, concomitant thyroid operation, and the weight of excised parathyroid tissue. Conclusion Localization examinations are performed in 2/3 of the patients, but limited neck exploration was performed in only approximately 1/3 of the operations. The cure rate was lower and postoperative hypocalcemia was more frequent than expected