Role of Thoracic Surgery in parathyroid surgery
Abstract Introduction and objective: The prevalence of ectopic parathyroids ranges from 6.3% to 26% in patients undergoing surgery due to hyperparathyroidism and mediastinal exploration is necessary in about 1-2% of patients with ectopic parathyroid. The objective of this article is to describe the particularities of surgical treatment of mediastinal parathyroids. Synthesis: Preoperative localization of ectopic parathyroids is essential to ensure the success of the intervention; dual phase scintigraphy with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) is considered the gold standard technique for its location. Intraoperative radioguided navigation with a gamma probe and intraoperative monitoring of PTH are useful for reducing surgical time and avoiding unnecessary re-examinations. Minimally invasive approaches (VATS or robotic surgery) for the exploration and removal of mediastinal lesions offer advantages over conventional open approaches such as magnification and better vision of structures and maneuverability. Conclusions: The success of surgical removal of ectopic parathyroids is based on the appropriate preoperative location. Radio-guided navigation with gamma probe and intraoperative PTH monitoring are useful to ensure adequate parathyroid resection. Minimally invasive approaches (VATS or robotic surgery) have reduced the need for sternotomy or thoracotomy.
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2. Dong JY, Guan Y, Zhu Y, Dong JY, Guan Y, Zhu Y et al. Surgical treatment of 368 cases of hyperthyroidism. Chin J Gen Surg. 2011;4:289-91.
3. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002; 235: 665–70.
4. Noussios G, Anagnostis P, Natsis K. Ectopic parathyroid glands and their anatomical, clinical and surgical implications. Exp Clin Endocrinol Diabetes. 2012; 120: 604–10.
5. Moran CA, Suster S. Primary parathyroid tumors of the mediastinum. Am J Clin Pathol. 2005; 124: 749–54.
6. Russell CF, Edis AJ, Scholz DA, Sheedy PF, van Heerden JA. Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg. 1981; 193: 805-9.
7. Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery. 1994; 116:999-1004.
8. Wei B, Inabnet W, Lee JA, Sonett JR. Optimizing the minimally invasive approach to mediastinal parathyroid adenomas. Ann Thorac Surg. 2011; 92:1012–17.
9. Taki J, Sumiya H, Tsuchiya H, Tomita K, Nonomura A, Tonami N. Evaluating benign and malignant bone and soft-tissue lesions with technetium-99m-MIBI scintigraphy. J Nucl Med. 1997;38: 501–6.
10. Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery. 2000;128: 29–35.
11. Iihara M, Suzuki R, Kawamata A, Horiuchi K, Okamoto T.. Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J Surg. 2012; 36: 1327–34.
12. Ishikawa T, Onoda N, Ogawa Y, Takashima T, Matsunaga N, Michigami S et al. Thoracoscopic excision for ectopic mediastinal parathyroid tumor. Biomed Pharmacother. 2002; 56(Suppl 1): 34s–36s.
13. Sagan D, Godziuk K. Surgical treatment of mediastinal parathyroid adenoma: rationale for intraoperative parathyroid hormone monitoring. Ann Thorac Surg 2010; 89: 1750–5.
14. Conn JM, Goncalves MA, Mansour KA, McGarity WC. The mediastinal parathyroid. Am Surg. 1991; 37: 62-6.
15. Doherty GM, Doppman JL, Miller DL, Gee MS, Marx SJ, Spiegel AM, et al. Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperthyroidism. Ann Surg. 1992; 215: 101-6.
16. Schlinkert RT, Whitaker MD, Argueta R. Resection of selected mediastinal parathyroid adenomas through an anterior mediastinotomy. Mayo Clin Proc. 1991; 66: 1110-3.
17. Wells SA, Cooper JD. Closed mediastinal exploration in patients with persistent hyperparathyroidism. Ann Surg. 1991; 214: 555-61.
18. Yutaka Y, Omasa M, Shikuma K, Taki T. Video-assisted mediastinoscopic resection of ectopic parathyroid adenoma. Asian Cardiovasc Thorac Ann. 2012; 20: 731-3.
19. Randone B, Costi R, Scatton O, Fulla Y, Bertagna X, Soubrane O et al. Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg. 2010; 251: 717-21.
20. Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery. 1994; 116:999-1004.
21. Alesina PF, Moka D, Mahlstedt J, Walz MK. Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg. 2008; 32:224-31.
22. Ismail M, Maza S, Swierzy M, Tsilimparis N, Rogalla P, Sandrock D et al. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg. 2010; 97: 337-43.
23. Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E. Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2011;21:e24-7.
24. Profanter C, Schmid T, Prommegger R, Bale R, Sauper T, Bodner J. Robot-assisted mediastinal parathyroidectomy. Surg Endosc. 2004;18:868-70.
2. Dong JY, Guan Y, Zhu Y, Dong JY, Guan Y, Zhu Y et al. Surgical treatment of 368 cases of hyperthyroidism. Chin J Gen Surg. 2011;4:289-91.
3. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002; 235: 665–70.
4. Noussios G, Anagnostis P, Natsis K. Ectopic parathyroid glands and their anatomical, clinical and surgical implications. Exp Clin Endocrinol Diabetes. 2012; 120: 604–10.
5. Moran CA, Suster S. Primary parathyroid tumors of the mediastinum. Am J Clin Pathol. 2005; 124: 749–54.
6. Russell CF, Edis AJ, Scholz DA, Sheedy PF, van Heerden JA. Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg. 1981; 193: 805-9.
7. Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery. 1994; 116:999-1004.
8. Wei B, Inabnet W, Lee JA, Sonett JR. Optimizing the minimally invasive approach to mediastinal parathyroid adenomas. Ann Thorac Surg. 2011; 92:1012–17.
9. Taki J, Sumiya H, Tsuchiya H, Tomita K, Nonomura A, Tonami N. Evaluating benign and malignant bone and soft-tissue lesions with technetium-99m-MIBI scintigraphy. J Nucl Med. 1997;38: 501–6.
10. Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery. 2000;128: 29–35.
11. Iihara M, Suzuki R, Kawamata A, Horiuchi K, Okamoto T.. Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J Surg. 2012; 36: 1327–34.
12. Ishikawa T, Onoda N, Ogawa Y, Takashima T, Matsunaga N, Michigami S et al. Thoracoscopic excision for ectopic mediastinal parathyroid tumor. Biomed Pharmacother. 2002; 56(Suppl 1): 34s–36s.
13. Sagan D, Godziuk K. Surgical treatment of mediastinal parathyroid adenoma: rationale for intraoperative parathyroid hormone monitoring. Ann Thorac Surg 2010; 89: 1750–5.
14. Conn JM, Goncalves MA, Mansour KA, McGarity WC. The mediastinal parathyroid. Am Surg. 1991; 37: 62-6.
15. Doherty GM, Doppman JL, Miller DL, Gee MS, Marx SJ, Spiegel AM, et al. Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperthyroidism. Ann Surg. 1992; 215: 101-6.
16. Schlinkert RT, Whitaker MD, Argueta R. Resection of selected mediastinal parathyroid adenomas through an anterior mediastinotomy. Mayo Clin Proc. 1991; 66: 1110-3.
17. Wells SA, Cooper JD. Closed mediastinal exploration in patients with persistent hyperparathyroidism. Ann Surg. 1991; 214: 555-61.
18. Yutaka Y, Omasa M, Shikuma K, Taki T. Video-assisted mediastinoscopic resection of ectopic parathyroid adenoma. Asian Cardiovasc Thorac Ann. 2012; 20: 731-3.
19. Randone B, Costi R, Scatton O, Fulla Y, Bertagna X, Soubrane O et al. Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg. 2010; 251: 717-21.
20. Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery. 1994; 116:999-1004.
21. Alesina PF, Moka D, Mahlstedt J, Walz MK. Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg. 2008; 32:224-31.
22. Ismail M, Maza S, Swierzy M, Tsilimparis N, Rogalla P, Sandrock D et al. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg. 2010; 97: 337-43.
23. Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E. Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2011;21:e24-7.
24. Profanter C, Schmid T, Prommegger R, Bale R, Sauper T, Bodner J. Robot-assisted mediastinal parathyroidectomy. Surg Endosc. 2004;18:868-70.
Jiménez-López, M. F., & Gómez-Hernández, M. T. (2019). Role of Thoracic Surgery in parathyroid surgery. Revista ORL, 11(3), 338–388. https://doi.org/10.14201/orl.21593
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