Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. Issue 6 (19th August 2019)

• Record Type: Journal Article
• Authors: Isaacs, K E; Belete, S; Miller, B J; Di Marco, A N; Kirby, S; Barwick, T; Tolley, N S; Anderson, J R; Palazzo, F F
• Is Part Of: BJS open. Volume 3:Issue 6(2019)
• Page Start: 743
• Page End: 749
• Publication Date: 2019-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50207
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video-assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem. Methods: Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications. Results: Over a 2-year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false-positive preoperative imaging. Conclusion: With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma. Graphical Abstract: The authors' unit recently adopted a thoracoscopic approach to mediastinal parathyroidectomy. Unit data for their case series of thoracoscopic parathyroidectomies are reviewed here, including preoperative workup and operative findings. Recommended approach to mediastinal adenomas