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Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease

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Abstract

Background

Parathyroid exploration through a standard cervical approach is adequate for the resection of most mediastinal parathyroid glands. A subset of mediastinal parathyroid glands causing hyperparathyroidism, however, cannot be removed in this manner.

Study Design

We reviewed our experience with the use of partial median sternotomy in the treatment of these patients.

Results

Over a 14-year period, all but 10 of 937 (1.1%) consecutive patients explored for hyperparathyroidism by a single endocrine surgeon were treated by a cervical approach. Partial median sternotomy was performed in 10 cases and was successful in seven cases (70%), with conversion to a complete sternotomy being required in three cases. Six of these seven patients had failed a previous parathyroid exploration (86%), including one patient who had a previous complete sternotomy. Cure of hyperparathyroidism was achieved in all seven patients undergoing partial median sternotomy. In five patients a mediastinal parathyroid gland was removed (71%), and in one patient a parathyroid adenoma in the carotid sheath was eventually found, and the location of the hyperfunctioning parathyroid gland in one patient was never determined although the patient was cured. The mean length of hospital stay after a partial median sternotomy was 2.6 days. One patient sustained a recurrent laryngeal nerve injury at the time of a repeat cervical exploration and partial median sternotomy.

Conclusions

Rarely, mediastinal parathyroid glands cannot be resected through a cervical approach. In these cases the use of partial median sternotomy is an attractive technique in achieving cure of hyperparathyroidism and is associated with minimal morbidity and a short length of hospital stay.

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Acknowledgments

The authors are grateful to Juan R. Garcia, Certified Medical Illustrator, for his artistic contributions.

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, Connecticut, 06520, USA

    Jason S. Gold MD, Patricia I. Donovan RN & Robert Udelsman MD, MBA

Authors
  1. Jason S. Gold MD
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  2. Patricia I. Donovan RN
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  3. Robert Udelsman MD, MBA
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Corresponding author

Correspondence to Robert Udelsman MD, MBA.

Additional information

Presented in part at the Society of Surgical Oncology 57th Annual Cancer Symposium, New York, NY, March 18–21, 2004

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Gold, J.S., Donovan, P.I. & Udelsman, R. Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease. World J. Surg. 30, 1234–1239 (2006). https://doi.org/10.1007/s00268-005-7904-z

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