Minimally Invasive Mediastinal Parathyroidectomy: An Effective and Safe Technique in Patients with Ectopic Primary Hyperparathyroidism

Abstract

Introduction: Primary hyperparathyroidism is a disease commonly caused by a single parathyroid adenoma in 80% - 85% of cases, and is less frequently caused by parathyroid hyperplasia. In approximately 2% of cases, the ectopic parathyroid adenoma is located within the mediastinum. Safely targeted parathyroidectomy is the gold standard procedure for surgical management of primary hyperparathyroidism. We reviewed our surgical experience using video-assisted thoracic surgery and a robotic technique for surgical resection of mediastinal parathyroid adenoma, caused by primary hyperparathyroidism. Materials and Methods: From July 2010 to September 2016, six consecutive patients with symptomatic primary hyperparathyroidism were evaluated with neck ultrasound computed tomography (CT), technetium-99 sestamibi scintigraphy, and selective venous sampling with a measurement of parathyroid hormone levels. Four patients underwent video-assisted thoracic parathyroidectomy and two patients had robotic-assisted parathyroidectomy. Results: In six patients, there were four women and two men with a mean age of 47.5 years (ranging from 31 - 60 years). The mediastinal parathyroid adenomas were successfully localized by preoperative imaging studies in five patients. Only in one patient, we were unable to localize the parathyroid adenoma. All parathyroid adenomas were successfully resected without any complications. Conclusions: We found that minimally invasive mediastinal parathyroidectomy is promising, safe, and effective in a selected group of patients, as well as providing superior cosmetic results and a short hospital stay.