Less is more: time to expand the indications for minimally invasive video-assisted parathyroidectomy

Minimally invasive video-assisted parathyroidectomy in dogs: Technique description and feasibility study

OBJECTIVE

To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism.

STUDY DESIGN

Surgical technique description and clinical case report.

ANIMALS

Five canine cadavers and 5 client-owned dogs with primary hyperparathyroidism.

METHODS

A surgical technique for minimally invasive video-assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases.

RESULTS

A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space.

CONCLUSION

Minimally invasive video-assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases.

CLINICAL SIGNIFICANCE

Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs.

Assessment of the Educational Quality, Accuracy, and Transparency of WebSurg Videos on Minimally Invasive Video-Assisted Parathyroidectomy

Background

The internet has changed the way both physicians and patients search for health information. WebSurg® is a valuable source of information that informs surgeons about new technologies and techniques and aims to promote quality, safety, and patient-centered care. In this study, our aim is to evaluate the popularity, quality, transparency, and accuracy of videos about minimally invasive video-assisted parathyroidectomy (MIVAP).

Materials and methods

A total of 31 videos related to MIVAP returned by the WebSurg® search engine in response to the keywords “MIVAP”, “video assisted parathyroidectomy’’, and “minimally invasive parathyroidectomy’’ were included in this study. Videos were evaluated in terms of time since upload, run time, country, academic degree, and the number of views and likes. The popularity of videos was determined by the video power index (VPI) formula. The DISCERN questionnaire score (DISCERNqs), global quality score (GQSc), and Journal of American Medical Association benchmark criteria (JAMABC) scoring systems were used to analyze WebSurg® videos for reliability and quality.

Results

The academic degree of the members was MD in 90.32% of uploaded videos. Forty-eight point thirty-eight percent (48.38%) of the videos were uploaded by members from France. There was no significant difference between the DISCERNqs, JAMABC, GQSc, and MIVAP scoring system (MIVAP-SS) scores in terms of academic degree and country. A statistically significant negative correlation was found between the time since upload and the VPI score (r=-0.683, p<0.001). The run time was positively correlated with the DISCERNqs, JAMABC, GQSc, and MIVAP-SS scores (p=0.003, p=0.002, p=0.003, p<0.001, respectively). For the MIVAP-SS score, the Spearman correlation analysis demonstrated a statistically significant positive correlation with VPI, DISCERNqs, JAMABC, and GQSc (p<0.05).

Conclusion

Videos about MIVAP are helpful for surgeons to learn the procedure step-by-step before the surgery they will be performing but still below the expected quality. It is recommended to use MIVAP-SS points, which is a novel scoring system, to ensure standardization and improve quality.

Day case parathyroidectomy: is this the right way for the patients?

Background

Minimally-invasive video-assisted parathyroidectomy (MIVAP) can be considered as the primary treatment of choice for single parathyroid adenoma. Often, this technique is performed in a day surgery setting and is associated with regional anaesthesia (RA). Many studies have already reported the feasibility and safety of MIVAP in day surgery. Here our focus has been on the patient's personal experience with these procedures through an assessment of their recovery at home.

Methods

We conducted a prospective observational study in the University Hospital of Pisa Day Surgery Unit. Forty-eight patients were enrolled and divided by personal choice of anaesthesia technique: a regional anaesthesia group (RAg) and general anaesthesia group (GAg). Data were extracted from the medical records and three questionnaires: the first was self-compiled at discharge (Q1), while the second (Q2) and the third (Q3) were administered as telephone surveys.

Results

None of the patients in RAg reported pain longer than 1 day after discharge, whereas 15% of patients in GAg reported pain relief the third day after discharge (P=0.0065). Discharge in RAg was within 3 hours in 12.5% of patients, within 4 hours in 78.1%, and within 5 hours in 9.4%. Discharge in GAg was within 5 hours in 53.8% and in more than 5 hours in 46.1% (P=0.0027).

Conclusions

Patients highly appreciated day-case parathyroidectomy. Furthermore, the association of RA with MIVAP leads to better results than those of general anaesthesia (GA) and MIVAP. Finally, we point out that it is fundamental that the physicians pay attention to what the patients consider important for them; that is, the personal meaning of the hospitalization.

Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series

PURPOSE

To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA).

METHODS

From March to November 2017, five cases of TOETVA were performed. Data reported include patient demographics, indication for surgery, extent of surgery, operative time, the need to convert to cervicotomy, the length of hospital stay and post-operative pain and morbidity. Unconventional complications regarded as specific for TOETVA were reported. The burden of surgery on the patient's quality of life was evaluated using the 36-item short form (SF-36) health survey 1 month after surgery.

RESULTS

All patients were females with a mean age of 36 years. They all underwent a right-sided hemithyroidectomy for a solitary thyroid nodule measuring on average 3.5 cm in size. The nodule was reported as Bethesda category II (n = 3), III (n = 1), and IV (n = 1) on fine needle aspiration cytology. The mean operative time was 122 min. Conversion to a transverse cervicotomy was required in one case. None of the patients developed post-operative bleeding, and none experienced vocal fold or mental nerve palsy. Surgical site infection did not occur. All patients developed subcutaneous emphysema that resolved within 12-48 h. All patients reported a long-standing bothersome pulling sensation along the surgical track that resulted in a poor outcome in some scales of the SF-36 survey. Flap perforation occurred in one case. The median VAS score was 3.

CONCLUSION

Patients strongly motivated to undergo a novel surgical procedure tailored to their needs and desires should be properly counselled particularly regarding unconventional procedure-related complications.