TITLE:
Minimally Invasive Mediastinal Parathyroidectomy: An Effective and Safe Technique in Patients with Ectopic Primary Hyperparathyroidism
AUTHORS:
Iskander Al-Githmi
KEYWORDS:
Primary, Hyperparathyroidism, Parathyroid Adenoma, Minimally Invasive, Parathyroidectomy, Mediastinum
JOURNAL NAME:
Open Journal of Thoracic Surgery,
Vol.7 No.4,
December
28,
2017
ABSTRACT: Introduction: Primary hyperparathyroidism is a disease commonly caused by a single
parathyroid adenoma in 80% - 85% of cases, and is less
frequently caused by parathyroid hyperplasia. In approximately 2% of cases, the
ectopic parathyroid adenoma is located within the mediastinum. Safely targeted
parathyroidectomy is the gold standard procedure for surgical management of
primary hyperparathyroidism. We reviewed our surgical experience using
video-assisted thoracic surgery and a robotic technique for surgical resection
of mediastinal parathyroid adenoma, caused by primary hyperparathyroidism. Materials and Methods: From
July 2010 to September 2016, six consecutive patients with symptomatic primary
hyperparathyroidism were evaluated with neck ultrasound computed tomography
(CT), technetium-99 sestamibi scintigraphy, and selective venous sampling with a
measurement of parathyroid hormone levels. Four patients underwent
video-assisted thoracic parathyroidectomy and two patients had robotic-assisted
parathyroidectomy. Results: In
six patients, there were four women and two men with a mean age of 47.5 years (ranging
from 31 - 60 years). The mediastinal
parathyroid adenomas were successfully localized by preoperative imaging
studies in five patients. Only in one patient, we were unable to localize the
parathyroid adenoma. All parathyroid adenomas were successfully resected
without any complications. Conclusions: We found that minimally invasive mediastinal parathyroidectomy is
promising, safe, and effective in a selected group of patients, as well as
providing superior cosmetic results and a short hospital stay.