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Transoral parathyroid surgery—a new alternative or nonsense?

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

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Conflicts of interest

There was no financial support by an external company and there are no conflicts of interest.

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Authors and Affiliations

  1. Department of General and Minimally Invasive Surgery, Kliniken Essen Mitte, Henrici Street 92, 45136, Essen, Germany

    Elias Karakas

  2. Department of Anesthesiology and Critical Care, University Hospital Marburg, Marburg, Germany

    Thorsten Steinfeldt & Andreas Gockel

  3. Department of Neurology, Municipial Hospital Kaufbeuren, Kaufbeuren, Germany

    Anton Mangalo

  4. Department of Head and Neck Surgery, Municipial Hospital Solingen, Solingen, Germany

    Andreas Sesterhenn

  5. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Marburg, Germany

    Detlef K. Bartsch

Authors
  1. Elias Karakas
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  2. Thorsten Steinfeldt
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  3. Andreas Gockel
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  4. Anton Mangalo
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  5. Andreas Sesterhenn
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  6. Detlef K. Bartsch
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Correspondence to Elias Karakas.

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Karakas, E., Steinfeldt, T., Gockel, A. et al. Transoral parathyroid surgery—a new alternative or nonsense?. Langenbecks Arch Surg 399, 741–745 (2014). https://doi.org/10.1007/s00423-014-1187-5

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  • DOI: https://doi.org/10.1007/s00423-014-1187-5

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