Grogan RH, Khafif AK, Nidal A, Anuwong A, Shaear M, Razavi CR, Russell JO, Tufano RP. One hundred and one consecutive transoral endoscopic parathyroidectomies via the vestibular approach for PHPTH: a worldwide multi-institutional experience.
Surg Endosc 2021;
36:4821-4827. [PMID:
34741203 DOI:
10.1007/s00464-021-08826-y]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
IMPORTANCE
The transoral vestibular approach for thyroid and parathyroid surgery is being adopted rapidly world-wide. Currently there is a paucity of information on this approach for primary hyperparathyroidism (PHPTH). If this approach is safe and efficacious it would provide patients a completely scarless option for parathyroidectomy.
OBJECTIVE
To determine whether parathyroidectomy via the transoral vestibular approach can be successfully done in a safe and efficient manner.
DESIGN
Consecutive case series of 101 transoral parathyroidectomies performed over a two-year period.
SETTING
Multi-institutional, academic, high-volume transoral thyroidectomy centers from the USA, Israel, and Thailand.
PARTICIPANTS
A consecutive series of adult patients with a biochemical diagnosis of classic PHPTH and who met criteria for parathyroidectomy based on established international consensus for surgery for PHPTH. All patients also had well-localized single adenomas on at least two preoperative imaging studies.
INTERVENTION
Transoral endoscopic parathyroidectomy vestibular approach.
MAIN OUTCOMES AND MEASURES
Surgical success rate defined by immediate intra or post-operative return to normal PTH values. Surgical complications including recurrent laryngeal nerve injury, permanent hypoparathyroidism, and infection.
RESULTS
Of the 101 consecutive transoral parathyroidectomy patients 84% were female with an average age of 54.23 ± 11.0 years and an average BMI of 27.35 ± 6.19. Ninety-nine out of the 101 patients had immediate return to normal PTH after resection for a surgical success rate of 98%. There were no permanent recurrent laryngeal nerve injuries, one temporary nerve palsy, and no permanent hypoparathyroidism. The median operative time dropped from 130.5 min (IQR 86) to 66.5 min (IQR 56) between the first- and second-half of cases.
CONCLUSION AND RELEVANCE
Transoral endoscopic parathyroidectomy via the vestibular approach is a scarless method of removing parathyroids that is clinically feasible, safe, and efficacious and is a reasonable option for focused minimally invasive parathyroidectomy that can be offered to select patients with PHPTH.
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