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First experience with minimally invasive video-assisted parathyroidectomy

Erste Erfahrungen mit der minimal-invasiven videoassistierten Parathyreoidektomie

  • Main Topic: Minimally Invasive Endocrine Surgery
  • Published:
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Summary

Background: Rapid development of endoscopic procedures has brought about innovation in the field of minimally invasive operative techniques. In consequence of improvement of preoperative localization diagnostics and intraoperative control measures, minimally invasive videoassisted parathyroidectomy (MIVAP) has been expanded to the field of parathyroid surgery.

Methods: Patients with preoperative localization of adenoma in primary hyperparathyroidism were selected in case of primary surgical intervention of the neck in a video-endoscopically assisted technique. Preoperative localization was performed by ultrasonography and sestamibi scintigraphy. Intraoperatively, quick-PTH-levels were assessed for control of successful adenoma-exstirpation.

Results: Of 62 patients with the diagnosis of PHPT, 16 patients could be selected for MIVAP. 13 out of 16 patients could be successfully completed applying the MIVAP-procedure. In 3 cases conversion to conventional parathyroidectomy became necessary. Morbidity was 6 % with 1 unilateral transient recurrent nervepalsy. There was no unsuccessful intervention in regard to the underlying disease, there was no recurrence of PHPT so far. In 2 cases additional resection of a thyroid nodule was performed videoassistedly. There was no case of postoperative hypoparathyroidism.

Conclusions: The preliminary experiences and results of MIVAP encourage further clinical experience in favour of it’s good results cosmetics results and advantages of shortened hospital stay and no postoperative hypoparathyroidism.

Zusammenfassung

Grundlagen: Die schnelle Entwicklung endoskopischer Operationsverfahren hat eine innovative Ausdehnung der Methode auf verschiedene operative Felder bewirkt. Im Zuge der Entwicklung präoperativer Lokalisationsdiagnostiken und intraoperativer Kontrollinstrumente für die erfolgreiche Operation erfolgte die Anwendung minimal-invasiver videoendoskopischer Technik (MIVAP) auf die Nebenschilddrüsen-Operation.

Methodik: Patienten mit eindeutiger präoperativer Adenomlokalisation bei PHPT wurden ausgewählt, sofern keine zervikalen Voroperationen bestanden. Präoperative Lokalisationsdiagnostik waren zervikale Sonographie und Sestamibiszintigraphie. Intraoperative quick-PTH-Bestimmung erfolgte zur Bestätigung der vollständigen Entfernung adenomatösen Nebenschilddrüsen-Gewebes.

Ergebnisse: Von 62 Patienten mit der Diagnose PHPT konnten 16 Patienten für die Methode ausgewählt werden. Davon konnten 13 Patienten erfolgreich mittels MIVAP operiert werden. In 3 Fällen erfolgte eine Ausdehnung des Eingriffes zur konventionellen Parathyreoidektomie. Die Morbidität betrug 6 % mit 1 unilateralen, passageren Recurrensparese. Hinsichtlich der Beseitigung der Grunderkrankung waren alle Operationen erfolgreich. Rezidive traten bisher nicht auf. In 2 Fällen erfolgte gleichzeitig die video-assistierte Entfernung von Schilddrüsenknoten. In keinem Fall kam es zu einem postoperativen Hypoparathyreoidismus.

Schlußfolgerungen: Die präliminären Ergebnisse der MIVAP-Methode ermutigen zu weiteren klinischen Anwendungen bei exzellenten kosmetischen Ergebnissen und Vorteilen hinsichtlich verkürzter Hospitalisierungszeiten und geringerer postoperativer Hypoparathyreoidismusrate.

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  1. Department of General Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097, Halle, Germany

    K. Lorenz, P. Nguyen-Thanh & H. Dralle M. D.

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  1. K. Lorenz
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  2. P. Nguyen-Thanh
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  3. H. Dralle M. D.
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Lorenz, K., Nguyen-Thanh, P. & Dralle, H. First experience with minimally invasive video-assisted parathyroidectomy. Acta Chir Austriaca 31, 218–220 (1999). https://doi.org/10.1007/BF02620167

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