Minimally invasive video-assisted right parathyroidectomy for hyperparathyroidism
Epublication WebSurg.com, Nov 2007;07(11). URL: http://websurg.com/doi/vd01en2153
This video demonstrates a minimally invasive approach to excision of a parathyroid adenoma. A mini-incision is placed transversely in the midline and the laparoscope provides a magnified image for dissection. Modified instruments from open surgery are used and all the parathyroid glands can potentially be accessed by this approach. This is the case of a 48-year-old female patient who has complained for several years of bone and muscular pain. Systematic preoperative diagnostic work-up showed hypercalcemia (3.5 mmol/L), hypophosphatemia (0.70 mol/L) and increased PTH levels (180 picograms/mL). A superior right parathyroid adenoma was suspected on cervical ultrasound. A CT-scan was performed preoperatively and a superior left parathyroid adenoma was found. MIBI scintigraphy evidenced an area of increased uptake consistent with this. A 2 cm suprasternal incision is carried out and the left lateral thyroid lobe is approached. The inferior thyroid artery and the left recurrent nerve are identified. These two structures are the major landmarks to correctly identify the parathyroid adenoma, which is then completely dissected before the pedicle is ligated.