Original article
Endoscopic lateral parathyroidectomy as surgical treatment for patients with primary hyperparathyroidism
Paratiroidectomía lateral endoscópica en el manejo de pacientes con hiperparatiroidismo primario
Óscar Vidal-Pérez
, Mauro Valentini, Juan Carlos Baanante-Cerdeña, César Ginestà-Martí, Laureano Fernández-Cruz, Juan Carlos García-Valdecasas
Corresponding author
ovidal@clinic.ub.es
Corresponding author at: Sección de Cirugía General y Endocrina, Hospital Clínic de Barcelona, Villarroel 170, escalera 9-4 planta, 08036 Barcelona, Spain. Tel.: +34 93 227 54 00 ext. 5552.
Corresponding author at: Sección de Cirugía General y Endocrina, Hospital Clínic de Barcelona, Villarroel 170, escalera 9-4 planta, 08036 Barcelona, Spain. Tel.: +34 93 227 54 00 ext. 5552.
Sección de Cirugía General y Endocrina, Servicio de Cirugía General y Digestiva, Instituto de Malalties Digestives i Metabolisme, Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
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Tel.: +34 93 227 54 00 ext. 5552." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paratiroidectomía lateral endoscópica en el manejo de pacientes con hiperparatiroidismo primario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 754 "Ancho" => 975 "Tamanyo" => 99590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Endoscopic exposure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">When Félix Mandel published the first case of conventional parathyroidectomy in 1925,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> this procedure was rapidly accepted by the surgical community for its excellent clinical results and because the steps to perform it correctly were clearly established from the start.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Until the present day, it has been considered that the intervention proposed by Mandel results in surgical success in more than 95% of patients operated for primary hyperparathyroidism, when the 4 glands are explored via a transverse cervicotomy.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> Five percent of therapeutic errors have been observed in patients with multigland disease, supernumerary glands, major ectopia or, exceptionally, a carcinoma. With conventional parathyroidectomy not only can we expect very low morbimortality and a hospital stay of under 48<span class="elsevierStyleHsp" style=""></span>h, it also offers excellent aesthetic results in the majority of patients. However, in recent years new technologies have been implemented, along with new approaches to parathyroidectomy: the unilateral approach,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3–5</span></a> radio-guided surgery,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6,7</span></a> minimally invasive open techniques (mini-incisions with or without local anaesthesia),<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8–10</span></a> and minimally invasive endoscopic techniques, video-assisted or fully endoscopic.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11–19</span></a> The common objectives of all these techniques have been: a smaller incision, compared to the traditional open approach (transverse cervical incision) and performing targeted surgery to one of the glands specifically, in order to reduce aggression to the patient, and ensure more rapid recovery, as usually the excision of a small benign tumour is sufficient, without the need for sutures or surgical flaps.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The development of these minimally invasive approaches has been associated with three things in the main: <span class="elsevierStyleItalic">first</span>, the availability of imaging techniques which would enable us to accurately locate the adenoma that needs to be excised; <span class="elsevierStyleItalic">second</span>, intraoperative determination of parathormone, which will confirm resection of the diseased gland (and thus avoid examination of the other glands), and <span class="elsevierStyleItalic">finally</span>, the application of technological advances, which have already been applied in other fields, such as mini-instruments, sealing devices and optics and small-diameter cameras, to perform this type of surgery. And furthermore, patients increasingly want a less visible scar on their necks for aesthetic reasons.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the fact that our group were pioneers in the development of this type of approach, since 1999 this endoscopic parathyroidectomy technique was used occasionally in our centre, and in 2010 we again included this technique in the routine therapeutic arsenal as an option that we offer to some of our patients with a diagnosis of primary hyperparathyroidism.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A prospective, descriptive study was carried out with patients aged over 18 who were attended in the General and Endocrine Surgery Unit of the <span class="elsevierStyleItalic">Hospital Clínic</span> in Barcelona, with a diagnosis of primary hyperparathyroidism.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All the patients were included consecutively during the period between 1 April 2010 and 30 December 2013.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of primary sporadic hyperparathyroidism was based on the clinical history and physical examination of the patient, which was complemented with laboratory tests (blood samples chest and abdomen X-rays; and a cervical ultrasound with preoperative MIBI gammagraphy), to confirm the solitary nature of the lesion.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The criteria for exclusion from the study were: medical-anaesthetic (ASA) or surgical contraindications in order to perform endoscopic surgery, the presence of a large goitre, or previous thyroid or parathyroid surgery, “impossibility of locating the adenoma with imaging tests” or the presence of an adenoma of a size greater than 3<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This study was approved by the Surgical Department of our institution and all the patients were informed of the possibility of other therapeutic options (conventional open surgery).</p><p id="par0050" class="elsevierStylePara elsevierViewall">All the patients were operated by the same team of surgeons, specialists in endocrinological disorders.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patients’ demographic variables were recorded (age and gender), and their clinical characteristics (date of admission, date of discharge, surgical time, intra-operative complications, post-operative pain [visual analogue scale 0–10], the time oral diet was started, hospital stay) and cure of the disease. Once the information had been gathered, a descriptive analysis of the variables was undertaken (median and range).</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0060" class="elsevierStylePara elsevierViewall">The cervical endoscopy was performed under general anaesthesia and the patient was placed in the supine position with open arms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The surgeon stood on the side of the diseased gland with their assistant to their right. Our technique consisted of using a 10<span class="elsevierStyleHsp" style=""></span>mm trocar and some 3<span class="elsevierStyleHsp" style=""></span>mm trocars in order to achieve good vision, and two useful work channels.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The 3 trocars were positioned on the line of the anterior edge of the sternocleidomastoid muscle (SCM) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The procedure was completed in 3 steps: <span class="elsevierStyleItalic">first step or open phase</span>: a 15<span class="elsevierStyleHsp" style=""></span>mm transverse incision was made over the anterior edge of the SCM, just caudal to the cricoid cartilage. The dissection was commenced on the plane between the anterior edge of the SCM and the posterior edge of the infrahyoid muscles, and just below the omohyoid muscle. Then the fascia that connects the posterior side of the thyroid lobe with the carotid vein, was carefully divided, enough to visualise the prevertebral fascia. In order to be able to expand the working area, one or 2 damp swabs were placed deeply above and below inside the initially created space.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The transparietal route of the 3<span class="elsevierStyleHsp" style=""></span>mm trocars was through the incision, from the outside to the inside. The route of the trocars needs to follow the anterior edge of the SCM, so that they can be placed in their site inside the space created initially.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">second step</span> of the operation is endoscopic exploration with CO<span class="elsevierStyleInf">2</span> pressure at 8<span class="elsevierStyleHsp" style=""></span>mm of mercury. Immediately after introducing the camera, and making a minimal dissection, all anatomical structures should be easily identified (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and the recurrent laryngeal nerve should be found first; if possible the ipsilateral gland should be checked.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The adenoma is gradually dissected from the adjacent structures, and isolated, and when it is possible to isolate the pedicle it is not necessary to continue with the endoscopic dissection. After removing the 4 trocars, the <span class="elsevierStyleItalic">third step</span> of this procedure is performed openly, through the opening of the largest trocar when the adenoma can be seen, and its pedicle can be sealed without any difficulty.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The adenoma is directly extracted through the same incision as the trocar, and it is not necessary to place a sterile protection bag. This approach, initially proposed to all the patients, was principally used for adenomas located behind the thyroid lobe.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our group a rapid intraoperative parathormone assay is not carried out, and instead, we perform anatomopathological analysis of the removed gland.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">We performed a total of 28 parathyroidectomies (20 women and 8 men), using the endoscopic technique. All the patients had sporadic primary hyperparathyroidism, and the mean age of the group was 68 (59–89). They were all classified as ASA I and II.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The recurrent laryngeal nerve was identified in 26 (95%) out of 28 cases, and the ipsilateral parathyroid gland in 14/28 (50%). A bilateral approach was necessary in one patient (3.5%), due to a false-negative result from imaging tests.</p><p id="par0105" class="elsevierStylePara elsevierViewall">We were obliged to undertake 4 conversions (14%) to open surgery (through a transverse cervicotomy), because multigland disease was observed during the procedures, which was not detected by the preoperative imaging tests in one case (3.5%), capsular rupture of the adenoma in another case (3.5%), and difficulties in the appropriate progression of the operation, in the first 2 cases (7%). The surgical time was 61.2 (40–90)<span class="elsevierStyleHsp" style=""></span>min and no intraoperative complications were detected. The mean weight of the tissue samples was 1087<span class="elsevierStyleHsp" style=""></span>mg (100–7080<span class="elsevierStyleHsp" style=""></span>mg).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Post-operative morbidity included permanent damage to the recurrent laryngeal nerve in one patient, one case of haematoma of the sternocleidomastoid muscle, and a capsular rupture which required conversion; the rupture case was probably due to the presence of a large, friable adenoma.</p><p id="par0115" class="elsevierStylePara elsevierViewall">All the patients started an oral diet within the first 12<span class="elsevierStyleHsp" style=""></span>h post surgery. Pain 24<span class="elsevierStyleHsp" style=""></span>h after the intervention was 2 (1–3) according to the visual analogue scale. The mean hospital stay was 1 (1–3) days.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The wounds had an excellent appearance 7 days after surgery, and were almost “invisible” 3 months after the intervention (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">After median follow-up of 22 (9–53) months, 2 patients continued to have hypercalcaemia after ablation of an adenoma (7%); the presence of a second ectopic adenoma was found in one patient, at the level of the mediastinum, and in the second patient, the cause of hypercalcaemia was not related to the base disease, and therefore we consider that the success of the intervention was 27/28 (96%).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Many advantages have been demonstrated of surgical interventions performed in the peritoneal cavity via endoscopy compared to the same performed as open surgery. These results have generated an interest in developing increasingly less invasive procedures in other anatomical territories, and the first application of endoscopy in parathyroid surgery to remove the parathyroid adenomas located in the mediastinum by thoracoscopy<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> was described in 1994; this avoids opening the thorax and offers the patient important advantages in these rare cases of ectopia. However, it is difficult to demonstrate the same advantages with cervical approaches, despite the wide series published by Henry et al. in the nineties<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> and Miccoli et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> We only found 2 studies in recent medical literature which compared conventional parathyroid surgery to endoscopic techniques, and these demonstrated less post-operative pain, and better aesthetic results with the endoscopic techniques.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16,17</span></a> From our experience, we believe that the use of endoscopic techniques could be better compared to the conventional approach, as it allows better quality visualisation of the surgical field (Full-HD), and greater magnification of all the anatomical structures, compared to open surgery. It is probably more difficult to achieve an adequate view of the anatomical structures through a mini-incision than with endoscopic vision.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study, one patient presented a permanent lesion to the recurrent laryngeal nerve in the post-operative period. We believe that the mechanism of the lesion probably occurred during the process of removing the adenoma, as the nerve was appropriately identified during the initial endoscopic dissection around the adenoma.</p><p id="par0140" class="elsevierStylePara elsevierViewall">According to the experience of groups such as that of Marsella,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> and our experience, only some patients with primary sporadic hyperparathyroidism are candidates for this type of surgery. Patients need to be strictly selected, and it is essential to evaluate the absolute contraindications which are: large goitre, previous surgery to the area near the parathyroid, suspicion of multigland disease and difficulty in localising the adenoma on imaging tests. According to some authors, more than 60% of patients with primary hyperparathyroidism could be candidates for video-assisted parathyroidectomy.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">15,16</span></a> In their publication in the journal <span class="elsevierStyleItalic">Surgery</span> in 2001 Henry et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> pointed out, that the contraindications can be relative as they depend on the experience of the surgeon of the surgical technique used, thus broadening the spectrum of possible candidates for endoscopy. We shall continue to strictly select patients, and evaluate absolute contraindications, since we have no hospitals designed for the surgical treatment of endocrinological disorders and, therefore the number of patients available to us is clearly lower than that reported in the various published studies.</p><p id="par0145" class="elsevierStylePara elsevierViewall">We had a case of glandular rupture which required conversion, probably owing to the presence of a large, friable adenoma. In the abovementioned series, large adenomas (>3<span class="elsevierStyleHsp" style=""></span>cm) were not considered an absolute contraindication, especially if located in the postero-superior mediastinum,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> although surgeons with little experience might encounter difficulties when dissecting large adenomas, which might result in capsular rupture, and local dissemination of adenomatous parathyroid cells<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">14,15</span></a>; and therefore we recommend excluding adenomas over 2<span class="elsevierStyleHsp" style=""></span>cm. In the case where this complication occurred we have not observed any sign of recurrence to date.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The lateral approach also enables full exploration of all the anatomical elements of the retro-thyroid area, from the upper pedicle to the postero-superior mediastinum, and therefore we consider that this procedure also applies to the cases where the parathyroid lesion is posteriorly located. In other words, the growth of the upper parathyroid glands pushes them to migrate posteriorly and slide over the paravertebral plane near to the lateral edge of the oesophagus.</p><p id="par0155" class="elsevierStylePara elsevierViewall">According to the studies published by Henry et al.,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> amongst other authors,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">12,15,18</span></a> the lateral approach is also ideal for parathyroid glands located posterior to the lower poles of the thyroid lobe and, in cases where it is important to have a lateral view to enable the recurrent laryngeal nerve to be located which is in intimate contact with the adenoma and only thus can it be safely dissected; however, for lower peri-thymic locations the central approach might be preferable.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In this cohort of 28 patients who underwent lateral endoscopic parathyroidectomy sensitivity to cervical ultrasound was 95%, and 98% for MIBI nuclear-scan. We know that the result of the ultrasound is dependent on the operator and that the MIBI scan was a strong determinant of the success of the endoscopy, and therefore could explain biased results from the selection process. After overall analysis of the imaging tests, we found that half of the conversions were caused by erroneous results, one case of multigland disease which went undetected, and one case due to underestimating the size of the adenoma on ultrasound.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Unfortunately, we cannot compare our results from the patients operated using endoscopy vs the patients in whom an open approach was used, as in our case they were considered to be different groups of patients; however, our results are similar to those reported by the series published to date.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">15–19</span></a> Unlike open surgery where only the confidence of the surgeon in his or herself is sufficient to achieve a successful result in more than 95% of cases, a video-assisted surgeon will rely on multiple technologies, especially surgical instruments and location studies of preoperative imaging.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Amongst the minimally invasive techniques which apply to parathyroidectomy, the video-assisted technique has the important advantage of offering a magnified view, which enables precise and careful dissection thus minimising risk. In our experience, in the right setting, cervical endoscopy and open surgery could be complementary techniques.</p><p id="par0175" class="elsevierStylePara elsevierViewall">It is very early to evaluate what the recurrence rate will be with these new techniques, and it would have to be compared with a very low rate of recurrence of the primary hyperparathyroidism after the open approach for solitary lesions.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0180" class="elsevierStylePara elsevierViewall">Although the endoscopic approach for sporadic primary hyperparathyroidism is feasible and reproducible, and offers results that are comparable with the traditional open approach, the technical difficulty in using this approach, which requires intensive training, together with the scarcity of clearly selectable patients (as a result of the dispersion of cases throughout the different national health service hospitals), make its use not very advisable outside hospitals with a high number of patients and different endocrine surgery departments, in which case it would form part of the range of surgical approaches which can be offered to each individual patient.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres611279" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec625308" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres611278" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec625307" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-14" "fechaAceptado" => "2015-05-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec625308" "palabras" => array:4 [ 0 => "Parathyroid" 1 => "Endoscopic lateral parathyroidectomy" 2 => "Endoscopic neck surgery" 3 => "Novel technique" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec625307" "palabras" => array:4 [ 0 => "Paratiroides" 1 => "Paratiroidectomía lateral endoscópica" 2 => "Cirugía cervical endoscópica" 3 => "Nuevos procedimientos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Most surgeons have rapidly accepted the use of minimally invasive surgical approaches for the treatment of primary hyperparathyroidism. The role of the endoscope in neck surgery is still being discussed due to its technical difficulty and complex patient selection criteria.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study was conducted between April 2010 and April 2013. It included patients diagnosed with sporadic primary hyperparathyroidism by locating a single adenoma using ultrasound and sestamibi scintigraphy imaging. All patients agreed to be included in the study. Experienced endocrine surgeons that had been trained in endocrine minimally invasive surgery performed the procedure. The same surgical technique was used in all of the cases. The demographic and clinical variables were evaluated. A descriptive analysis was performed on the data measuring mean, standard deviation, and range.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 28 endoscopic lateral parathyroidectomies were performed. All patients were diagnosed with sporadic primary hyperparathyroidism. The mean age was 68 years (59–89). No intraoperative complications were registered. Postoperative morbidity was comparable to that reported in the classical approach. A favourable outcome was observed in 27 of the 28 patients (96%) after a mean follow-up time of 22 (9–53) months.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An endoscopic approach for sporadic primary hyperparathyroidism is feasible and reproducible, and it obtains comparable results to the classical open surgery. Several factors make this technique suitable for highly specialised hospitals with a high patient volume and specialised endocrine surgery units.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La mayoría de los cirujanos han aceptado de una manera rápida, la realización de miniprocedimientos abiertos para el tratamiento del hiperparatiroidismo primario. Sin embargo, la utilización de la endoscopia cervical sigue siendo discutible por su dificultad técnica y la estricta selección de los pacientes.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre los meses de abril del 2010 y del 2013, se incluyó a pacientes con hiperparatiroidismo primario esporádico, que además tenían un adenoma único tanto por ecografía y exploración con sestamibi, y que aceptaron participar en el estudio. Los pacientes fueron operados por cirujanos especialmente entrenados en este tipo de cirugía, utilizando la misma técnica quirúrgica en todos ellos. Se recogieron variables demográficas y características clínicas de los pacientes. Una vez finalizada la recolección de información se procedió al análisis descriptivo de las variables: mediana, desviación estándar y, rango.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos un total de 28 paratiroidectomías mediante el abordaje de paratiroidectomía lateral endoscópica. La edad media de los pacientes fue de 68 años (59-89). Todos los pacientes tuvieron un hiperparatiroidismo primario esporádico. No se detectaron complicaciones intraoperatorias. La morbilidad fue comparable con la que muestran series publicadas en técnica abierta. Tras una mediana de seguimiento de 22 (9-53) meses, hemos detectado que el éxito de la intervención ha sido de 27/28 (96%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El abordaje endoscópico del primario esporádico resulta factible, reproducible y ofrece unos resultados comparables al abordaje clásico abierto, diversos factores hacen poco recomendable su realización fuera de hospitales con alto volumen de pacientes y unidades diferenciadas de Cirugía Endocrina.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vidal-Pérez O, Valentini M, Baanante-Cerdeña JC, Ginestà-Martí C, Fernández-Cruz L, García-Valdecasas JC. Paratiroidectomía lateral endoscópica en el manejo de pacientes con hiperparatiroidismo primario. Cirugía y Cirujanos. 2016;84:15–20.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 136298 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Positioning of the patient.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 795 "Ancho" => 975 "Tamanyo" => 135859 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Positioning of the trocars in the neck.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 754 "Ancho" => 975 "Tamanyo" => 99590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Endoscopic exposure.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1318 "Ancho" => 975 "Tamanyo" => 211805 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Aesthetic result one month after surgical intervention.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutischer versuch ber ostitis fribrosa generalisata mittels extirpation eine epithelkorpercher-tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 0 | 5 |
| 2024 October | 20 | 3 | 23 |
| 2024 September | 25 | 4 | 29 |
| 2024 August | 17 | 0 | 17 |
| 2024 July | 15 | 3 | 18 |
| 2024 June | 54 | 1 | 55 |
| 2024 May | 36 | 4 | 40 |
| 2024 April | 29 | 7 | 36 |
| 2024 March | 49 | 4 | 53 |
| 2024 February | 47 | 2 | 49 |
| 2024 January | 69 | 4 | 73 |
| 2023 December | 74 | 7 | 81 |
| 2023 November | 60 | 14 | 74 |
| 2023 October | 68 | 9 | 77 |
| 2023 September | 27 | 6 | 33 |
| 2023 August | 29 | 4 | 33 |
| 2023 July | 51 | 6 | 57 |
| 2023 June | 35 | 2 | 37 |
| 2023 May | 67 | 6 | 73 |
| 2023 April | 70 | 3 | 73 |
| 2023 March | 45 | 2 | 47 |
| 2023 February | 51 | 4 | 55 |
| 2023 January | 49 | 4 | 53 |
| 2022 December | 27 | 8 | 35 |
| 2022 November | 55 | 8 | 63 |
| 2022 October | 44 | 10 | 54 |
| 2022 September | 87 | 18 | 105 |
| 2022 August | 40 | 5 | 45 |
| 2022 July | 36 | 9 | 45 |
| 2022 June | 38 | 14 | 52 |
| 2022 May | 44 | 7 | 51 |
| 2022 April | 35 | 6 | 41 |
| 2022 March | 53 | 5 | 58 |
| 2022 February | 46 | 7 | 53 |
| 2022 January | 71 | 12 | 83 |
| 2021 December | 46 | 10 | 56 |
| 2021 November | 45 | 11 | 56 |
| 2021 October | 28 | 8 | 36 |
| 2021 September | 42 | 16 | 58 |
| 2021 August | 35 | 8 | 43 |
| 2021 July | 15 | 9 | 24 |
| 2021 June | 32 | 12 | 44 |
| 2021 May | 32 | 6 | 38 |
| 2021 April | 60 | 19 | 79 |
| 2021 March | 68 | 22 | 90 |
| 2021 February | 51 | 9 | 60 |
| 2021 January | 42 | 16 | 58 |
| 2020 December | 47 | 9 | 56 |
| 2020 November | 44 | 8 | 52 |
| 2020 October | 30 | 10 | 40 |
| 2020 September | 30 | 9 | 39 |
| 2020 August | 53 | 10 | 63 |
| 2020 July | 30 | 12 | 42 |
| 2020 June | 17 | 10 | 27 |
| 2020 May | 33 | 10 | 43 |
| 2020 April | 23 | 2 | 25 |
| 2020 March | 36 | 4 | 40 |
| 2020 February | 30 | 11 | 41 |
| 2020 January | 20 | 3 | 23 |
| 2019 December | 21 | 5 | 26 |
| 2019 November | 10 | 10 | 20 |
| 2019 October | 11 | 1 | 12 |
| 2019 September | 27 | 6 | 33 |
| 2019 August | 5 | 2 | 7 |
| 2019 July | 15 | 6 | 21 |
| 2019 June | 25 | 21 | 46 |
| 2019 May | 140 | 43 | 183 |
| 2019 April | 37 | 23 | 60 |
| 2019 March | 12 | 1 | 13 |
| 2019 February | 10 | 11 | 21 |
| 2019 January | 6 | 8 | 14 |
| 2018 December | 6 | 8 | 14 |
| 2018 November | 17 | 5 | 22 |
| 2018 October | 19 | 11 | 30 |
| 2018 September | 4 | 3 | 7 |
| 2018 August | 8 | 5 | 13 |
| 2018 July | 2 | 1 | 3 |
| 2018 June | 3 | 5 | 8 |
| 2018 May | 3 | 7 | 10 |
| 2018 April | 2 | 8 | 10 |
| 2018 March | 5 | 0 | 5 |
| 2018 February | 3 | 1 | 4 |
| 2018 January | 2 | 0 | 2 |
| 2017 December | 2 | 0 | 2 |
| 2017 November | 8 | 2 | 10 |
| 2017 October | 18 | 2 | 20 |
| 2017 September | 9 | 12 | 21 |
| 2017 August | 6 | 1 | 7 |
| 2017 July | 14 | 2 | 16 |
| 2017 June | 16 | 1 | 17 |
| 2017 May | 18 | 6 | 24 |
| 2017 April | 10 | 21 | 31 |
| 2017 March | 14 | 33 | 47 |
| 2017 February | 18 | 3 | 21 |
| 2017 January | 20 | 1 | 21 |
| 2016 December | 16 | 5 | 21 |
| 2016 November | 9 | 2 | 11 |
| 2016 October | 23 | 4 | 27 |
| 2016 September | 30 | 5 | 35 |
| 2016 August | 20 | 2 | 22 |
| 2016 July | 11 | 2 | 13 |
| 2016 June | 28 | 8 | 36 |
| 2016 May | 26 | 24 | 50 |
| 2016 April | 27 | 13 | 40 |
| 2016 March | 55 | 23 | 78 |
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