Mediastinal Videothoracoscopic Parathyroidectomy for Primary Sporadic Hyperparathyroidism-a Case Series Analysis

Primary hyperparathyroidism is one of the commonest endocrine diseases requiring surgical parathyroidectomy for its cure. Surgical excision through conventional open neck approach and sternotomy/thoracotomy for mediastinal parathyroid adenomas not accessible through neck is the treatment of choice. In this context, we evaluated the feasibility and safety of a thoracoscopic technique for mediastinal parathyroidectomy. This is a case series analysis conducted at a tertiary care endocrine surgery department, between May 2016 and August 2019. We employed a novel thoracoscopic route for parathyroidectomy in biochemically diagnosed sporadic primary hyperparathyroidism and radiologically localized mediastinal parathyroid tumours. All the clinical, investigative, operative, pathological and postoperative data were collected from our prospectively filled database. Statistical analysis was performed with SPSS 20.0 version. Under general anaesthesia, access to chest was obtained with 3 ports (three 10 mm triangulated port sites through 3rd, 4th and 5th intercostal spaces) insufflated with 6 mmHg CO2(carbothorax) for working space. Mediastinal pleura was opened overlying the adenoma, internal mammary vein was clipped and meticulous dissection was performed to devascularise the lesion, without breaching its capsule. Excised specimen was delivered through one of the ports after placing it in custom-made endobag. Out of the 67 hyperparathyroidism cases operated during the study period, 6 (9%) were operated by this technique. Mean operative time was 142.5 SD 14.5 min (105-170). The postoperative course was uneventful with no mortality, persistent hypercalcemia or recurrent laryngeal nerve palsy. Cure and diagnosis were confirmed by > 50% fall in intraoperative serum parathyroid hormone levels and histopathology (all were benign solitary adenomas). Through this study, we propose that our thoracoscopic mediastinal parathyroidectomy is a feasibly safe approach for primary sporadic hyperparathyroidism.