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



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.


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.


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.


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


NOTES Transoral Parathyroid surgery 


  1. 1.
    Bergenfelz A, Kanngiesser V, Zielke A, Nies C, Rothmund M (2005) Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg 92(2):190–197PubMedCrossRefGoogle Scholar
  2. 2.
    Lorenz K, Miccoli P, Monchik JM, Düren M, Dralle H (2001) Minimally invasive video-assisted parathyroidectomy: multiinstitutional study. World J Surg 25(6):704–707PubMedCrossRefGoogle Scholar
  3. 3.
    Barczyński M, Cichoń S, Konturek A, Cichoń W (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30(5):721–731PubMedCrossRefGoogle Scholar
  4. 4.
    Grant CS, Thompson G, Farley D, van J H (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140(5):472–478PubMedCrossRefGoogle Scholar
  5. 5.
    Berti P, Materazzi G, Picone A, Miccoli P (2003) Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 90(6):743–747PubMedCrossRefGoogle Scholar
  6. 6.
    Irvin GL 3rd, Solorzano CC, Carneiro DM (2004) Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg 28(12):1287–1292PubMedCrossRefGoogle Scholar
  7. 7.
    Henry JF, Sebag F, Cherenko M, Ippolito G, Taieb D, Vaillant J (2008) Endoscopic parathyroidectomy: why and when? World J Surg 32(11):2509–2515PubMedCrossRefGoogle Scholar
  8. 8.
    Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 232(3):331–339PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Duh QY (2003) Minimally invasive endocrine surgery: standard of treatment or hype? Surgery 134:849–857PubMedCrossRefGoogle Scholar
  10. 10.
    Shimizu K, Shiba E, Tamaki Y, Takiguchi S, Tanigushi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillobilateral breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201CrossRefGoogle Scholar
  11. 11.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRefGoogle Scholar
  12. 12.
    Henry JF (2008) Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 393:621–626PubMedCrossRefGoogle Scholar
  13. 13.
    Karakas E, Steinfeldt T, Gockel A, Westermann R, Kiefer A, Bartsch DK (2010) Transoral thyroid and parathyroid surgery. Surg Endosc 24(6):1261–1267PubMedCrossRefGoogle Scholar
  14. 14.
    Karakas E, Steinfeldt T, Gockel A, Schlosshauer T, Dietz C, Jäger J, Westermann R, Sommer F, Richard HR, Exner C, Sesterhenn A, Bartsch DK (2011) Transoral thyroid and parathyroid surgery—development of a new transoral technique. Surgery 150:108–115PubMedCrossRefGoogle Scholar
  15. 15.
    Witzel K, von Rahden BHA, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875PubMedCrossRefGoogle Scholar
  16. 16.
    Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M (2009) Natural orifice surgery on thyroid gland: totally tranoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23(5):1119–1120PubMedCrossRefGoogle Scholar
  17. 17.
    Benhidjeb T, Harlaar J, Kerver A, Kleinrensink GJ, Wilhelm T (2010) Transorale endoskopische Thyreoidektomie. Chirurg 81(2):134–138PubMedCrossRefGoogle Scholar
  18. 18.
    Wilhelm T, Metzig A (2010) Video. Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24(7):1757–1758PubMedCrossRefGoogle Scholar
  19. 19.
    Nakaio A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, Ishigami S, Ueno S, Yoshinaka H, Natsugou S (2013) Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27(4):1105–1110CrossRefGoogle Scholar
  20. 20.
    Richmon JD, Holsinger FC, Kandil E, Moore MW, Garcia JA, Tufano RP (2011) Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique. J Robot Surg 5(4):279–282PubMedCentralPubMedCrossRefGoogle Scholar

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

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