Minimally invasive resection for mediastinal ectopic parathyroid glands.

Abstract

BACKGROUND:

We reviewed our experience with ectopic mediastinal parathyroidectomy.

METHODS:

Between March 1980 and September 2010, mediastinal parathyroidectomy was performed in 33 patients with hypercalcemia secondary to hyperparathyroidism.

RESULTS:

Primary hyperparathyroidism was the main diagnosis in 32 patients (97%). Technetium-sestamibi scan was used in 23 (70%) for preoperative localization. Minimally invasive resections were performed in 18 patients (55%), and 15 (45%) underwent open surgery. The most common minimally invasive surgery approach was video-assisted thoracoscopy in 9 patients (27%); the most common open approach was median sternotomy in 11 (33%). Intraoperative parathyroid hormone monitoring was used in 22 patients (67%). The ectopic glands were intrathymic in 15 patients (45%), in the aortopulmonary window in 7 (21%), and in other intrathoracic locations in the remaining 11 (33%). Parathyroid adenomas were identified in 21 patients (64%); parathyroid hyperplasia and carcinoma were identified in 9 (27%) and 3 (9%), respectively. No early mortality occurred in either group. Reoperation was required in 1 patient in the minimally invasive surgery group because of hemothorax. Morbidity occurred in 8 patients (24%), the most common of which was hypocalcemia in 4 (12%). The mean length of stay was significantly shorter in the minimally invasive surgery group (2 versus 6 days; p < 0.001) but mortality and morbidity were not statistically different between the two groups (p = 0.05). Mean follow-up was 3 ± 3.7 years.

CONCLUSIONS:

Minimally invasive mediastinal parathyroidectomy has similar outcomes to open surgery, with significantly shorter length of hospital stay.

• Authors: Sameh M Said, Stephen D Cassivi, Mark S Allen, Claude Deschamps, Francis C Nichols 3rd, K Robert Shen, Dennis A Wigle
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 96 Issue 4 Pg. 1229-1233 (Oct 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23968765 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Choristoma (complications, surgery)
• Female
• Humans
• Male
• Mediastinal Diseases (complications, surgery)
• Middle Aged
• Minimally Invasive Surgical Procedures
• Parathyroid Glands
• Parathyroidectomy (methods)
• Retrospective Studies