Minimally Invasive Video-assisted Parathyroidectomy: An Initial Experience Of 37 Cases

Objective To investigate the safety, feasibility and effectiveness of minimally invasive video-assisted parathyroidectomy (MIVAP) for primary hyperparathyrodism.Methods We retrospectively analyze the clinical data of 37 primary hyperparathyroidism patients underwent MIVAP in our hospital from May 2005 to Jan. 2010. A 2 cm skin transverse incision was made above the sternal notch. Without gas insufflation, a cavity was built with retractors. Under endoscopic assistance, parathyroidectomy was performed by using a harmonic scalpel and subtotal thyroidectomy was performed simultaneously in cases combined with thyroid adenoma. Intraoperative parathyroid hormone level was tested in partial cases. All the focuses were identified and localized by ultrasound, 99Tcm-MIBI scan and by CT scan sometimes preoperatively .In the last 10 patients, we used Intraoperative Parathyroid Hormone test and compared the clinical data with the other 27 patients.Results All of the operations were successfully accomplished without conversion to open surgery. The mean time of operation was 78(30-150) min. No hoarseness, choking cough, or hemorrhage occurred postoperatively. A transient hypocalcemia developed in almost all cases. All the patients were followed for 23(5-60) months. All the patients were satisfied with the perfect cosmetic results and no recurrence occurred. Compared with the others, the use of Intraoperative Parathyroid Hormone test did not prolong the period of operation and increase the incidence of complications.Conclusions With careful localization, minimally invasive video-assisted parathyroidectomy appears to be a safe,feasible and effective treatment with good cosmetic results for primary hyperparathyroidism. We got the same effect when Intraoperative Parathyroid Hormone test was used together and it did not prolong the operation time.