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Surgical Endoscopy

, Volume 31, Issue 11, pp 4832–4833 | Cite as

Primary hyperparathyroidism treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA)

  • Thanyawat Sasanakietkul
  • Tobias CarlingEmail author
Video

Abstract

Background

Bilateral open cervical exploration with identifying all parathyroid glands and removing one or more enlarged parathyroid tumor(s) was the standard of care in primary hyperparathyroidism (pHPT). With the introduction of preoperative imaging and intraoperative parathyroid hormone (IOPTH) measurements [1, 2], various minimally invasive parathyroidectomy approaches have been developed, both open and endoscopic [3, 4, 5, 6, 7, 8]. The most commonly used approach currently in the USA is the minimally invasive open parathyroidectomy (MIP), which can be performed in the ambulatory setting with excellent cure and minimal complication rates [9, 10, 11, 12]. However, the operation requires a cervical incision, with occasionally poor cosmesis. The transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) provides a novel “scarless” approach to parathyroid surgery.

Methods

The aim of the video is to provide detailed instruction of the TOEPVA in pHPT and how to interpret IOPTH measurements in this setting.

Results

The TOEPVA uses three incisions in the vestibule of the oral cavity, using two 5-mm ports and one central 11-mm port. The subplatysmal space is enlarged by hydrodissection and manual dilation. The working space is enhanced by insufflation to 6 mmHg. With the adjunct of preoperative imaging and IOPTH measurements, the extent of the operation is tailored to achieve biochemical cure.

Conclusions

TOEPVA is feasible and safe and provides an excellent cosmetic outcome. It is a more direct approach than other remote endoscopic parathyroidectomy techniques. TOEPVA is an excellent option for select patients with pHPT wishing to avoid a neck incision.

Keywords

Endoscopic NOTES Parathyroidectomy Parathyroid adenoma Primary hyperparathyroidism Scarless Transoral 

Notes

Acknowledgements

Dr. Robert Udelsman and Dr. Angkoon Anuwong are thanked for assisting with the transoral operations.

Compliance with ethical standards

Disclosures

Dr.Thanyawat Sasanakietkul and Dr.Tobias Carling declare that there is no conflict of interests or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 157312 kb)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Surgery, Section of Endocrine SurgeryYale University School of MedicineNew HavenUSA

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