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2010, Number 4

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Cir Gen 2010; 32 (4)

Parathyroidectomy through a lateral approach

Jean-François H, Sierra M

Language: Spanish
References: 26
Page: 208-213
PDF size: 192.72 Kb.


ABSTRACT

Objective: The objective of this retrospective study was to assess the indications and the results of an endoscopic parathyroidectomy with lateral approach (EPLA) in the management of primary hyperparathyroidism (PHPT).
Setting: Service of Endocrine and Digestive Surgery. Hospital de La Timone; Marsella, Francia. Design: Retrospective and descriptive study of a series of patients with primary hyperparathyroidism, subjected to surgery using EPLA.
Statistical analysis: Descriptive statistics.
Patients and methods: From 1998 to 2009, 1,709 patients with PHPT were operated in our Service. We proposed a minimally invasive parathyroidectomy (MIP) for patients with sporadic PHPT, in whom only one adenoma had been located through ultrasonography and exploration with sestamibi. MIP was performed in patients with superficially located adenomas and EPLA in patients with deeply located adenomas. EPLA was performed in the anterior border of the sternocleidomastoid muscle (SCM). Along all the surgical procedures, an assay was performed for fast detection of the parathyroid hormone (rPTH).
Results: Of the 1709 patients, 785 (45.9%) were not eligible for MIP due to: associated large multinodular goiter (296 cases), inconclusive location studies (231 cases), previous ipsilateral cervical surgery (117 cases), suspicion of multiglandular disease (83 cases) and miscellaneous causes (58 cases). MIP was performed in 924 patients (54.1%); open MIP in 184 cases and EPLA in 740 cases. Conversion to conventional parathyroidectomy was required in 97 cases (10.5%) because: no adenoma was (27 cases), difficulties for the dissection of a large adenoma occupying most of the working space (22 cases), false-positive imaging studies (21 cases), and a fast drop in the rPTH assay (27 cases). Post-surgical morbidity included permanent damage to the laryngeal nerve in 3 patients, 3 hematomas in the SCM muscle,and 11 capsular ruptures. No deaths occurred. Five patients presented persistent hypercalcemia. One patient persisted with hypercalcemia not related to PHPT. Another patient presented recurrent PHPT.
Conclusion: Among the different minimal invasive techniques developed for patients with PHPT, EPLA should not oppose other procedures. EPLA complements the open MIP, it is indicated in patients parathyroid adenomas located deeply in the neck. The open MIP should be reserved for patients with superficially located adenomas. This emphasizes the role played by the preoperative imaging studies in the management of patients with PHPT eligible for a minimally invasive procedure.


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