Langenbeck's Archives of Surgery

, Volume 399, Issue 6, pp 741–745

Transoral parathyroid surgery—a new alternative or nonsense?

  • Elias Karakas
  • Thorsten Steinfeldt
  • Andreas Gockel
  • Anton Mangalo
  • Andreas Sesterhenn
  • Detlef K. Bartsch
Original Article

DOI: 10.1007/s00423-014-1187-5

Cite this article as:
Karakas, E., Steinfeldt, T., Gockel, A. et al. Langenbecks Arch Surg (2014) 399: 741. doi:10.1007/s00423-014-1187-5

Abstract

Purpose

In recent years, several endoscopic techniques have been explored in thyroid and parathyroid surgery, but only few gained acceptance among patients and surgeons. Based on extensive human cadaver and animal studies, we developed a technique for transoral partial parathyroidectomy (TOPP), which was performed for the first time in a patient with primary hyperparathyroidism (pHPT). We now report on results and the acceptance of this new technique 2 years after its implementation.

Methods

A pilot study was initiated to recruit a total of 10 patients with benign sporadic pHPT and a preoperatively localized parathyroid adenoma eligible for initial parathyroidectomy. The study protocol was approved by the ethics committee, and an insurance for unforeseen complications and risks was procured. Data of all patients evaluated and operated were prospectively collected, and follow-up examinations were carried out for 19 months on average, which included clinical examinations; ultrasonography; Ear, Nose, and Throat (ENT) investigations; and blood testing.

Results

Between January 2010 and May 2012, 75 patients with pHPT and a preoperative localized parathyroid adenoma were eligible for TOPP. After detailed information about the transoral procedure, only five (7 %) female patients consent to undergo TOPP. In three patients, a parathyroid adenoma could be removed via the transoral access, In two patients, the procedure had to be converted to the conventional technique. Median time until resection of a parathyroid adenoma was 122 min (range, 45–175). One patient had a transient recurrent laryngeal nerve palsy, while one patient suffered from a transient palsy of the right hypoglossal nerve and a slight but persisting dysgeusia. Three patients developed a hematoma of the mouth floor and swallowing problems. In four patients, the visual analog scale (VAS) pain score was high (>7) within the first 2 postoperative days.

Conclusions

Although TOPP is feasible, it is poorly accepted by patients and its complication rate is high. Thus, TOPP is nonsense with currently available devices.

Keywords

NOTESTransoralParathyroid surgery

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Elias Karakas
    • 1
  • Thorsten Steinfeldt
    • 2
  • Andreas Gockel
    • 2
  • Anton Mangalo
    • 3
  • Andreas Sesterhenn
    • 4
  • Detlef K. Bartsch
    • 5
  1. 1.Department of General and Minimally Invasive SurgeryKliniken Essen MitteEssenGermany
  2. 2.Department of Anesthesiology and Critical CareUniversity Hospital MarburgMarburgGermany
  3. 3.Department of NeurologyMunicipial Hospital KaufbeurenKaufbeurenGermany
  4. 4.Department of Head and Neck SurgeryMunicipial Hospital SolingenSolingenGermany
  5. 5.Department of Visceral, Thoracic and Vascular SurgeryUniversity Hospital MarburgMarburgGermany