Abstract
Background
Hypertrophic mediastinal parathyroid glands (HMPGs) play a role in recurrent secondary hyperparathyroidism (SHPT). Thoracoscopic retrieval of HMPGs has been proposed.
Methods
Twelve patients with recurrent SHPT owing to HMPGs were enrolled. We divided the locations of HMPGs below the innominate vein and right to the ascending aorta as Zone I, those below the innominate vein and left to the ascending aorta as Zone II, and those between the aortic arch and pulmonary artery as Zone III. Sestamibi scans combined with computed tomography (CT) scans were arranged to identify the location of HMPGs. Three trocars of the right or left thoracoscopic approach were applied for Zone I or Zone II; four trocars of the left thoracoscopic approach were applied for Zone III.
Results
Sestamibi and CT scans could positively find the 15 parathyroid glands of the 12 patients. Thirteen HMPGs were retrieved successfully with a thoracoscopic approach. The mean operation time was 155 min (range 80–292) and the mean hospital stay was 5.9 days (4–8). After a mean follow-up of 29.6 months (3–61), calcium and intact parathyroid hormone levels returned to normal ranges in all patients except for one who preferred two-stage surgery. Neither perioperative mortality, nor major complications occurred.
Conclusions
HMPGs in recurrent SHPT may be multiple. Sestamibi scans combined with CT scans can guide optimal approaches. The thoracoscopic approach provides a safe and feasible technique in retrieving HMPGs in Zones I or II using 3 trocars. For HMPGs in Zone III, they should be handled with care using 4 trocars.
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References
Pitt SC, Sippel RS, Chen H (2009) Secondary and tertiary hyperparathyroidism. State of the art surgical management. Surg Clin North Am 89:1227–1239
Gasparri G, Camandona M, Abbona GC et al (2001) Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233:65–69
Skinner KA, Zuckerbraun L (1996) Recurrent secondary hyperparathyroidism. An argument for total parathyroidectomy. Arch Surg 131:724–727
Chou FF, Lee CH, Chen HY et al (2002) Persistent and Recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Ann Surg 235:99–104
Numano M, Tominaga Y, Uchida K et al (1998) Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg 22:1098–1103. doi:10.1007/s002689900524
Prinz RA, Lonchyna V, Carnaille B et al (1994) Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 116:9991004
Russell CF, Edis AJ, Scholz DA et al (1981) Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg 193:805–809
Mariette C, Pellissier L, Combemale F et al (1998) Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 383:174–179
Ismail M, Maza S, Tsilimparis N et al (2010) Resection of ectopic mediastinal parathyroid glands with the da Vinci Robotic System. Br J Surg 97:337–343
Gotway MB, Reddy GP, Webb WR et al (2001) Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 218:783–790
Imene Z, Arman P, Zarni W et al (2001) Anatomical and functional localization of ectopic parathyroid adenomas: 6-year institutional experience. Nucl Med Commun 32:496–502
Roslyn JJ, Gordon HE, Mulder DG (1983) Mediastinal parathyroid adenomas. A cause of persistent hyperparathyroidism. Am Surg 49:523–527
Conn JM, Goncalves MA, Mansour KA et al (1991) The mediastinal parathyroid. Am Surg 57:62–66
Medrano C, Hazelrigg SR, Landreneau RJ et al (2000) Thoracoscopic removal of ectopic parathyroid glands. Ann Thorac Surg 69:221–223
Alesina PF, Moka D, Mahlstedt J et al (2008) Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg 32:224–231. doi:10.1007/s00268-007-9303-0
Randone B, Costi R, Scatton O et al (2010) Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg 251:717–721
Rothmund M, Wagner PK, Schark C et al (1991) Subtotal versus total parathyroidecotmy and sutotransplantation in secondary hyperparathyroidism. World J Surg 15:745–750. doi:10.1007/BF01665309
Tominaga Y, Katayama A, Sato T et al (2003) Reoperation is frequently required when parathyroid glands remain after initial parathyroidectomy fpr advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant 18(Suppl 3):iii65–iii67
Pattou FN, Pellissier LC, Noel C et al (2000) Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. Word J Surg 24:1330–1334. doi:10.1007/s002680010220
Richard ML, Wormuth J, Bingener J et al (2006) Parathyroidecotmy in secondary hyperparathyroidism: is there an optimal operative management? Surgery 139:174–180
Arnault V, Beaulieu A, Lifante J-C et al (2010) Multicenter study of 19 aortoplmonary window parathyroid tumors: the challenge of embryologic origin. World J Surg 34:2211–2216. doi:10.1007/s00268-010-0622-1
Nilubo N, Beyer T, Prinz RA et al (2007) Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome. Am J Surg 194:53–56
Henry JF, Defechereux T, Raffaelli M et al (2000) Supermemerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperparathyroidism. Ann Chir 125:247–252
Piga M, Bolasco P, Satta L et al (1996) Double phase parathyroid technetium 99-m MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism. J Nucl Med 37:565–569
Tominaga Y, Tanaka Y, Uchida K et al (1989) Preoperative localization of supernumerary and ectopic parathyroid glands in patients with secondary hyperparathyroidism. J Jpn Surg Soc 90:1057–1064
Iacobone M, Mondi I, Viel G et al (2010) The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 paients. Langenbecks Arch Surg 395:947–953
Cupisti K, Dotzenrath C, Simon D et al (2002) Therapy of suspected intrathoracic parathyroid adenoma: experience using open transthoracic approach and video-assisted thoracoscopic surgery. Lanagenbecks Arch Surg 386:488–493
Ravipati NB, Mclemore EC, Schilker RT et al (2008) Anterior mediastinotomy for parathroidecotmy. Am J Surg 195:799–802
Di Bisceglie M, Voltolini L, Paladini P et al (1998) Ectopic parathyroid adenoma: two cases treated with video-assisted thoracoscopic surgery. Scand Cardio-vasc J 32:51–52
Kao CL, Chou FF, Chang JP (2003) Minimal invasive surgery for resection of parathyroid tumor in the aortopulmonary window. J Cardiovasc Surg 44:139–141
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Lu, HI., Chou, FF., Chi, SY. et al. Thoracoscopic Removal of Hypertrophic Mediastinal Parathyroid Glands in Recurrent Secondary Hyperparathyroidism. World J Surg 39, 400–409 (2015). https://doi.org/10.1007/s00268-014-2797-3
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DOI: https://doi.org/10.1007/s00268-014-2797-3