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Duman S, Sarıgül A, Erdoğdu E, Özkan B, Demir A, Kara M, Toker SA. Video-Assisted Thoracoscopic Surgery Is a Safe and Feasible Technique for Mediastinal Parathyroid Lesions. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38639341 DOI: 10.1089/lap.2024.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.
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Affiliation(s)
- Salih Duman
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Arda Sarıgül
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Eren Erdoğdu
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Adalet Demir
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Murat Kara
- Department of Thoracic Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - S Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
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Tay YZ, Balasubbiah N, Awang RR, Retna Pandian BD, Sathiamurthy N. A Surgical Management of Mediastinal Parathyroid Adenoma: A Regional Experience in Malaysia. Cureus 2024; 16:e56792. [PMID: 38650780 PMCID: PMC11034996 DOI: 10.7759/cureus.56792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution's surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023. All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATS was performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.
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Affiliation(s)
- Yen Zhir Tay
- General Surgery, Thoracic Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
| | | | - Raflis Ruzairee Awang
- General Surgery, Breast and Endocrine Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
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Anemoulis M, Kachtsidis V, Geropoulos G, Panagiotopoulos N. Robot-Assisted Thoracoscopic Resection of Ectopic Parathyroid Tissue in Mediastinum: A Scoping Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:17-22. [PMID: 38344802 DOI: 10.1177/15569845231225668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Ectopic parathyroid tissue in the mediastinum represents a rare and potentially serious clinical entity with challenging diagnostic and surgical management. The main surgical approach for this issue is open thoracotomy, which is a safe technique but carries risks and complications associated with such as extensive surgery. The purpose of this study is to demonstrate robotic thoracic surgery as an alternative and potentially advantageous method to treat patients with ectopic parathyroid adenomas compared with open and video-assisted thoracoscopic surgery approaches. A total of 13 reports in the literature were identified that provided details in terms of complications, surgical approach, and results of minimally invasive surgical resection of mediastinal ectopic parathyroid tissue.
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Affiliation(s)
- Marios Anemoulis
- School of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Georgios Geropoulos
- School of Medicine, Aristotle University of Thessaloniki, Greece
- Department of General Surgery, Victoria Hospital, NHS Fife, Kirkcaldy, UK
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Spillane C, Calpin G, Singh S, O’Reilly K, Hehir C, Hill A, Magee C, Barrett H. A case of mediastinal hyperparathyromatosis. J Surg Case Rep 2024; 2024:rjad735. [PMID: 38250132 PMCID: PMC10799250 DOI: 10.1093/jscr/rjad735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Recurrent hyperparathyroidism (HPT) after initial parathyroid surgery occurs rarely in an ectopic location. The rare phenomenon of parathyromatosis may be the cause of this. We present the case of a 59-year-old woman with recurrent HPT, which presented as a new ectopic mediastinal parathyroid gland 13 years after initial 3.5 gland parathyroidectomy. A 1.5 × 1.3 cm lesion was discovered as an incidental finding in the pretracheal region, closely abutting the aortic arch. An aspirate revealed oncocytic cells, which were positive for parathyroid hormone, confirming a mediastinal parathyroid nodule. Sestamibi scan confirmed an avid nodule in the mediastinum. This patient had multiple co-morbidities but was asymptomatic of HPT. It was therefore decided at multi-disciplinary team discussion that she should undergo surveillance. To our knowledge, no such presentations have been reported in the literature. Thus, our case report is a unique addition of an atypical presentation of HPT.
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Affiliation(s)
- Chloe Spillane
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Gavin Calpin
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Sneha Singh
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Kasie O’Reilly
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Cian Hehir
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Arnold Hill
- Department of Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Colm Magee
- Department of Medicine, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
| | - Helen Barrett
- Department of Pathology, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0, Ireland
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Ohara Y, Kadomatsu Y, Kikumori T, Chen-Yoshikawa TF. Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1. Surg Case Rep 2023; 9:114. [PMID: 37341946 DOI: 10.1186/s40792-023-01694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Hyperparathyroidism in patients with multiple endocrine neoplasia 1 is attributed to the excessive secretion of parathyroid hormone (PTH) from multiple parathyroid glands. This can be successfully treated through complete resection of the parathyroid glands; however, subsequent surgery is often required because of the presence of supernumerary or ectopic parathyroid glands. Therefore, identifying the locations of all functional glands is crucial for precise resection. Here, we report a case of ectopic mediastinal parathyroid adenoma that was successfully resected using robot-assisted thoracoscopic surgery. CASE PRESENTATION A 53-year-old woman underwent a total parathyroidectomy with autotransplantation for multiple endocrine neoplasia 1-associated primary hyperparathyroidism. The patient previously underwent laparoscopic distal pancreatectomy for a pancreatic neuroendocrine tumor. She also presented with a mediastinal tumor and nonfunctional pituitary adenoma that could be followed up. Blood tests before total parathyroidectomy showed high levels of intact PTH (183 pg/mL) and calcium (Ca; 10.3 mg/dL); however, postoperative blood tests still revealed high levels of intact PTH (103 pg/mL) and Ca (11.4 mg/dL). Computed tomography and magnetic resonance imaging revealed a 45-mm-sized mass in the right upper mediastinum as a well-defined solid and cystic lesion, whereas 99mTc-methoxyisobutylisonitrile scintigraphy indicated a strong accumulation of tracers, suggesting an ectopic lesion in the mediastinum. Persistent hyperparathyroidism after total parathyroidectomy via neck incision was attributed to an ectopic parathyroid tumor in the mediastinum. Thus, we decided to resect the tumor using robot-assisted thoracoscopic surgery to perform the procedure gently and carefully. During surgery, a mediastinal tumor was identified as it was detected radiographically. Because it did not invade the surrounding tissues, it could be completely resected without injuring the capsule. The patient was discharged without complications. Postoperatively, Ca and intact PTH levels decreased back to normal. The final pathological diagnosis confirmed that the mass was an ectopic mediastinal parathyroid adenoma. CONCLUSIONS Minimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery.
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Affiliation(s)
- Yuko Ohara
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Toyone Kikumori
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
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Badhe PV, Patil S, Vikram Reddy G, Sheshadri H, Jain S, Nikumbh T. Slipped capital femoral epiphysis as primary presentation in an adolescent with primary hyperparathyroidism due to ectopic mediastinal parathyroid adenoma. Clin Case Rep 2023; 11:e7498. [PMID: 37361665 PMCID: PMC10288011 DOI: 10.1002/ccr3.7498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Key Clinical Message Ectopic mediastinal parathyroid adenoma causes primary hyperparathyroidism presenting as hypercalcemia. When children with hypercalcemia present with slipped capital femoral epiphysis, a detailed evaluation for hypercalcemia must be done before surgery. Abstract The association between slipped capital femoral epiphysis (SCFE) and hyperparathyroidism has been reported and is rare. Each is known to affect different age groups. We report a case of a 13-year-old boy with SCFE and primary HPT leading to hypercalcemia and skeletal deformities.
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Affiliation(s)
| | | | - G. Vikram Reddy
- Department of RadiologySeth GSMC and KEM hospitalMumbaiIndia
| | | | | | - Tejas Nikumbh
- Department of Internal MedicineThe Wright Center for Graduate Medical EducationScrantonPennsylvaniaUSA
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Iijima Y, Ishikawa M, Iwai S, Yamagata A, Kishimoto K, Motono N, Uramoto H. Robotic resection of ectopic mediastinal parathyroid adenoma with intraoperative parathyroid hormone monitoring: a case report. J Cardiothorac Surg 2022; 17:195. [PMID: 35987641 PMCID: PMC9392913 DOI: 10.1186/s13019-022-01935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Primary hyperparathyroidism is a disease caused by the secretion of excess parathyroid hormone (PTH) owing to the enlargement of the parathyroid gland. Ectopic parathyroid glands exist in the mediastinum in approximately 1–2% of cases, which is relatively rare. Intraoperative monitoring of serum PTH level is important to assess whether the source of hyperparathyroidism has been eliminated. Case presentation A 53-year-old asymptomatic woman was diagnosed with ectopic mediastinal parathyroid adenoma. A three-port robotic partial resection of the thymus containing the tumor was attempted, but bleeding from a swollen pericardial diaphragmatic vein led to the addition of an assist port along the way. The PTH level was measured intraoperatively. After confirming that the 15-min PTH level after removal of the tumor was less than 50% of the baseline value, the operation was completed. The tumor was positive for PTH and was diagnosed as an ectopic mediastinal parathyroid adenoma. Some small ectopic parathyroid gland tissues were observed in other parts of the thymic tissue. Serum calcium and PTH levels decreased and normalized. Conclusions We report the usefulness of robotic resection for ectopic mediastinal parathyroid adenoma with PTH monitoring. However, histopathologically, small parathyroid gland tissues may remain in the surrounding thymus. Hence, we believe that a strict follow-up is required for parathyroid function in the future.
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Ramos R, Rivas F, Macía I, Escobar I, Ureña A. Robotic posterosuperior mediastinal parathyroid adenoma resection. Cir Esp 2022; 100:453-455. [PMID: 35752444 DOI: 10.1016/j.cireng.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, Barcelona, Spain.
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ivan Macía
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Prevertebral cervical approach to posterior mediastinum parathyroid adenomas. Surg Endosc 2022; 36:6319-6325. [PMID: 35608699 DOI: 10.1007/s00464-022-09279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND About 4 years ago, we described the pure endoscopic cervical approach to posterior mediastinum parathyroid adenomas, which we called the "prevertebral cervical approach". At that time, we had operated on three patients and did not have enough quality videos to demonstrate this approach. After broadening our experience, we present our results and show this technique through a video. METHODS From June 2015 to January 2021, information on patients undergoing the prevertebral cervical approach was obtained from a specific prospective database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. The step by step technique is described for both right- and left-sided adenomas, by means of a short video clip. RESULTS Ten patients were operated on using this technique. Seven adenomas were right-sided and three were left-sided. The mean surgical time was 33 ± 7 min. There were neither intraoperative nor major postoperative complications. Seven patients presented with a slight subcutaneous emphysema, which did not cause complaints. All patients were discharged the day after surgery, except for one patient with a previous open neck removal of four glands due to secondary hyperparathyroidism, which required calcium replacement. Calcium and parathyroid hormone levels were normalised in the other nine patients after surgery. One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. The postoperative cosmetic outcomes were excellent. CONCLUSION In our experience, the pure cervical endoscopic approach has shown a high feasibility and short operation time, with excellent postoperative results regarding patient comfort, length of stay and disease cure. This approach also offers a very reasonable procedure cost, and may result in a less aggressive surgical option when compared with thoracic approaches.
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Rückert JC, Elsner A, Andreas MN. [Mediastinal Tumors]. Zentralbl Chir 2022; 147:99-120. [PMID: 35235970 DOI: 10.1055/a-1674-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.
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Affiliation(s)
- Jens-Carsten Rückert
- Chirurgische Klinik Campus Charité Mitte, Charité Universitätsmedizin, Berlin, Deutschland
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Split Sternotomy in Retrosternal Thyroid and Mediastinal Parathyroid Pathologies. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:318-324. [PMID: 34712072 PMCID: PMC8526232 DOI: 10.14744/semb.2021.76401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022]
Abstract
Objectives Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated. Methods The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated. Results Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44-83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients. Conclusion Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.
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Primary hyperparathyroidism due to mediastinal parathyroid lesions. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:55-59. [PMID: 34552645 PMCID: PMC8442087 DOI: 10.5114/kitp.2021.105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/16/2021] [Indexed: 12/05/2022]
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Ramonell KM, Rentas C, Buczek E, Porterfield J, Lindeman B, Chen H, Fazendin J, Wei B. Mediastinal parathyroidectomy: Utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases. Am J Surg 2021; 223:681-685. [PMID: 34481661 DOI: 10.1016/j.amjsurg.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The majority of ectopic mediastinal parathyroid adenomas are accessible transcervically and those not amenable to this approach pose a significant clinical and technical challenge. METHODS Retrospective review of transthoracic robot-assisted mediastinal parathyroidectomy (TTRMP) for primary hyperparathyroidism between 2012 and 2019 at a single institution. RESULTS 16 patients underwent TTRMP, 63% were female with a mean age of 64 ± 2.0 years. Nine of 16 had prior parathyroidectomy; 80% had persistent disease and a mean 2.8-year delay from index operation until TTRMP. Locations included: intrathymic (8), AP window (4), carina (3), and retroesophageal (1). Two patients underwent parathyroid reimplantation. Mean post-operative calcium and PTH were 9.2 ± 0.2 mg/dL and 20.2 ± 5.6 pg/mL, respectively. Complications included: temporary hypocalcemia (4), permanent hypocalcemia (1), DVT (1), hoarseness (1), and subcostal neuralgia (1). CONCLUSION In experienced hands, TTRMP is a safe and effective approach to mediastinal parathyroids not accessible transcervically. A multidisciplinary approach should be used in reoperative cases.
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Affiliation(s)
- Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, 1808 7th Ave South, BDB Suite 511, Birmingham, AL, 35233, USA.
| | - Courtney Rentas
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Erin Buczek
- University of Alabama at Birmingham, Department of Otolaryngology - Head and Neck Surgery, USA
| | - John Porterfield
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, USA
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Herbert Chen
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Jessica Fazendin
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Benjamin Wei
- University of Alabama at Birmingham, Department of Surgery, Division of Cardiothoracic Surgery, USA
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Panchangam RB, Mayilvaganan S. Mediastinal Videothoracoscopic Parathyroidectomy for Primary Sporadic Hyperparathyroidism—a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ramos R, Rivas F, Macía I, Escobar I, Ureña A. Robotic posterosuperior mediastinal parathyroid adenoma resection. Cir Esp 2021; 100:S0009-739X(21)00168-8. [PMID: 34140135 DOI: 10.1016/j.ciresp.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, Barcelona, Spain.
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ivan Macía
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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How to do depends on where it settles: Mediastinal parathyroid adenomas. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:340-346. [PMID: 32551165 DOI: 10.5606/tgkdc.dergisi.2020.18764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate demographic characteristics, preoperative adenoma localization, surgical techniques selected according to the size and localization of adenoma, and clinical results of patients undergoing mediastinal parathyroid adenoma excision. Methods Medical records of a total of 11 patients (4 males, 7 females; mean age 52.6 years; range, 25 to 65 years) who underwent excision of mediastinal parathyroid adenoma in our clinic between January 2011 and June 2019 were retrospectively reviewed. Data including demographic characteristics, complaints, preoperative serum calcium, phosphorus, and parathyroid hormone levels, preoperative imaging methods, surgical method, localization and size of adenoma, length of hospital stay, and duration and amount of drainage were recorded. Results Adenoma was localized in anterior mediastinum in seven patients and in the middle mediastinum in four patients. The mean diameter calculated by taking into account the longest diameter of parathyroid adenoma was 21.1 mm. The mean drainage duration was 3.5 days in two patients undergoing median sternotomy, five days in one patient undergoing thoracotomy, 1.2 days in three patients undergoing video-assisted thoracoscopic surgery, and 0.6 days in five patients undergoing robotic surgery. Conclusion Minimally invasive approaches such as videoassisted thoracoscopic surgery and robotic-assisted surgery are safe and effective approaches for excision of mediastinal parathyroid adenoma.
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Vetshev PS, Zhivotov VA, Ablitsov AY, Drozhzhin AY, Sudilovskaya VV. [Combination of toxic multinodular goiter and primary hyperparathyroidism with rare ectopia of parathyroma]. Khirurgiia (Mosk) 2020:89-93. [PMID: 31994506 DOI: 10.17116/hirurgia202001189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A well-known feature of primary hyperparathyroidism (PHPT) is possible ectopic localization of parathyroid adenoma that can significantly complicate diagnostic process. Ectopia in the aortic window is extremely rare and accounts only 1% of ectopic parathyroid adenomas in the mediastinum and 0.24% among all parathyroid adenomas. Combination of multinodular toxic goiter and primary hyperparathyroidism with a rare variant of ectopia makes this observation very valuable from scientific and practical point of view.
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Affiliation(s)
- P S Vetshev
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - V A Zhivotov
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - A Yu Ablitsov
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - A Yu Drozhzhin
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
| | - V V Sudilovskaya
- Pirogov National Medical Surgical Center of the Ministry of Health of the Russia, Moscow, Russia
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18
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JIMÉNEZ-LÓPEZ MF, GÓMEZ-HERNÁNDEZ MT. Papel de la Cirugía Torácica en la cirugía de paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Isaacs KE, Belete S, Miller BJ, Di Marco AN, Kirby S, Barwick T, Tolley NS, Anderson JR, Palazzo FF. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open 2019; 3:743-749. [PMID: 31832580 PMCID: PMC6887896 DOI: 10.1002/bjs5.50207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem. Methods Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications. Results Over a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging. Conclusion With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.
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Affiliation(s)
- K E Isaacs
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - S Belete
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - B J Miller
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK
| | - A N Di Marco
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - S Kirby
- Department of Radiology Imperial College Healthcare NHS Trust London UK
| | - T Barwick
- Department of Anaesthesia Imperial College Healthcare NHS Trust London UK
| | - N S Tolley
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
| | - J R Anderson
- Department of Cardiothoracic Surgery, Hammersmith Hospital Imperial College Healthcare NHS Trust London UK
| | - F F Palazzo
- Department of Endocrine Surgery Imperial College Healthcare NHS Trust London UK.,Department of Surgery & Cancer Imperial College London UK
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Li X, Wei Y, Shao H, Peng L, An C, Yu MA. Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study. Int J Hyperthermia 2019; 36:647-653. [PMID: 31305184 DOI: 10.1080/02656736.2019.1627429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Wei
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
| | - Hongzeng Shao
- Department of Ultrasound, The Fourth People's Hospital of Zibo, Zibo, China
| | - Lili Peng
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ming-An Yu
- Interventional Ultrasound Center, China-Japan Friendship Hospital, Beijing, China
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Hewes PD, Galey KM, Peyre CG, Hobbs SK, Ruan DT, Moalem J. Video-Assisted Thoracoscopic Resection of a Mediastinal Ectopic Parathyroid Adenoma. VideoEndocrinology 2019. [DOI: 10.1089/ve.2018.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philip D. Hewes
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Kelly M. Galey
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Christian G. Peyre
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Susan K. Hobbs
- Department of Radiology, University of Rochester Medical Center, Rochester, New York
| | - Daniel T. Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacob Moalem
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
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Thoracoscopic removal of ectopic mediastinal parathyroid adenoma causing hyperparathyroidism: a rare entity. Wideochir Inne Tech Maloinwazyjne 2018; 13:546-550. [PMID: 30524629 PMCID: PMC6280090 DOI: 10.5114/wiitm.2018.75896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/03/2018] [Indexed: 11/29/2022] Open
Abstract
Ectopic mediastinal parathyroid adenomas are uncommon. Here, we report the successful thoracoscopic removal of a mediastinal parathyroid adenoma from a patient with hypercalcemia. A 58-year-old female patient was referred to our department with persistent hypercalcemia. Serum calcium and phosphorus levels were 13.2 mg/dl and 2.5 mg/dl respectively, while the intact parathormone level was 798.9 pg/ml. Parathyroid computed tomography revealed a solid and well-defined mass at the anterior mediastinum close to the distal aorta. Once the contrast was enhanced, our pre-diagnosis was ectopic parathyroid adenoma. The mass was detected at the anterior mediastinum, dissected free from the surrounding tissue and excised. The capsulated mass, which had a diameter of 3 × 1.5 × 0.7 cm, was confirmed as parathyroid adenoma histopathologically. Postoperative calcium and parathormone levels decreased dramatically to normal levels. Anterior mediastinal localization of an ectopic parathyroid adenoma is a rare entity. The transsternal approach is the most preferred method, but video-thoracoscopy can be used safely and effectively.
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Thoracoscopic approach in the treatment of ectopic thymic parathyroid adenoma. Wideochir Inne Tech Maloinwazyjne 2018; 13:270-277. [PMID: 30002763 PMCID: PMC6041573 DOI: 10.5114/wiitm.2018.73331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/07/2018] [Indexed: 11/17/2022] Open
Abstract
Primary hyperparathyroidism is overproduction of parathyroid hormone, causing hypercalcemia. Parathyroid adenomas have been found to be the etiology for 80% of cases of primary hyperparathyroidism, while almost a quarter of them are ectopic. We present a case of ectopic thymic parathyroid adenoma, treated by the thoracoscopic approach. Preoperative computed tomogram and technetium-99-sestamibi imaging showed an adenoma, located in the front mid-mediastinum, approximately 8 × 10 mm in size. Resection of the tumor was indicated according to the persistent hypercalcemia after unsuccessful surgical treatment performed 3 years ago. It was decided to perform a parathyroidectomy during thoracoscopy. The diagnosis of parathyroid adenoma was established on postoperative histopathology staining. The patient was discharged from hospital 5 days after the surgery. We found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.
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Cvasciuc T, Mihai R, Black E. Video-Assisted Thoracoscopic Parathyroidectomy for an Ectopic Parathyroid Adenoma. VideoEndocrinology 2018. [DOI: 10.1089/ve.2017.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Titus Cvasciuc
- Department of Endocrine Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Radu Mihai
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Edward Black
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Toktaş O, İliklerden Ü, Yerlikaya B, Kotan Ç, Batur A. Transcervical resection of two parathyroid adenomas located on the anterior mediastinum. Turk J Surg 2018; 34:247-249. [PMID: 30302432 DOI: 10.5152/turkjsurg.2017.3270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/19/2015] [Indexed: 11/22/2022]
Abstract
The mediastinum is a possible location of ectopic parathyroid adenoma. Most ectopic parathyroid glands in the mediastinum are found in the superior mediastinum within the thymus. In this article, two cases with ectopic mediastinal parathyroid adenomas that were excised via transcervical resection are presented. Preoperative examination of the two cases was performed. Laboratory tests supported hyperparathyroidism. For both patients, the results of radiologic and scintigraphic examinations of the cases were compatible with parathyroid adenoma masses in the anterior mediastinum. Transcervical resection was performed via suprasternal incision through the sternal notch and the posterior wall of the sternum space by blunt dissection with the finger. The soft lesions were removed en bloc in both cases. The parathyroid hormone levels of the two cases decreased dramatically after the operation. Transcervical resection may be an alternative method to major surgery in anterior mediastinal small masses.
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Affiliation(s)
- Osman Toktaş
- Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Ümit İliklerden
- Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Baran Yerlikaya
- Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Çetin Kotan
- Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Turkey
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Makay Ö, Durmaz SF, Özdemir M, Şimşir I, İçöz G, Akyıldız M. Robot-assisted endoscopic mediastinal parathyroidectomy. Turk J Surg 2018; 34:315-318. [PMID: 30664431 DOI: 10.5152/ucd.2017.3437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
Ectopic parathyroid glands can be located at any anatomical location from the base of the tongue to the mediastinum. One-third of these glands migrate deep into the mediastinum, which are not accessible with a low cervical incision. In this article, we described the robotic approach to an ectopic mediastinal parathyroid gland. This management method of mediastinal adenomas has significant advantages when compared to conventional surgery.
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Affiliation(s)
- Özer Makay
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Said F Durmaz
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Nederlands
| | - Murat Özdemir
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Ilgın Şimşir
- Division Endocrinology and Metabolic Diseases, Department of Internal Medicine, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Gökhan İçöz
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Mahir Akyıldız
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
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Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report. Int J Surg Case Rep 2017; 40:120-123. [PMID: 28988020 PMCID: PMC5635244 DOI: 10.1016/j.ijscr.2017.08.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The most common cause of chronic hypercalcemia is primary hyperparathyroidism (PHPT). However, owing to the diverse presentation of hypercalcemia, the diagnosis often goes unnoticed culminating as a continuum of recurrence of symptoms. Nephrolithiasis, decreased bone mineral density and peptic ulcer disease are the main clinical sequelae. Among the causes of PHPT 80% are caused by parathyroid adenomas (PA). However, only rarely, these adenomas are found ectopically. PRESENTATION OF CASE We present the case of a 66-year-old female with a history of recurrent renal stones and peptic ulcer disease. She was found to have elevated serum calcium and PTH levels. However, subsequent high resolution CT scan of chest and neck failed to demonstrate any abnormality. Therefore, an anterior planar Technetium-99m-sestamibi (MIBI) scintigraphy scan using a single-tracer was done and it identified ectopic anterior mediastinal parathyroid adenoma. The patient was successfully managed with video-assisted thoracoscopic surgery and excision of the mass with follow up calcium level monitoring. DISSCUSSION An elevated calcium level should prompt a thorough workup, as sometimes it's the only clue to the unrelated and diversified systemic manifestations of hypercalcemia. Hyperparathyroidism due to ectopic adenoma is quite rare and possess a diagnostic and management challenge. CONCLUSION Symptomatic hypercalcemia and high level of PTH without local PA should alert physicians to search for ectopic locations through imaging. VATS is a safe and effective minimally invasive procedure for the resection of ectopic mediastinal PA and it should be considered as the first line approach for resection of these ectopic tumors.
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Ishikawa M, Sumitomo SI, Imamura N, Nishida T, Mineura K. A rare case of mediastinal functioning parathyroid adenoma removed successfully with thoracoscopy. J Surg Case Rep 2017; 2017:rjx070. [PMID: 28458875 PMCID: PMC5400454 DOI: 10.1093/jscr/rjx070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/25/2017] [Indexed: 01/07/2023] Open
Abstract
We report here a rare case of primary hyperparathyroidism that was associated with an ectopic parathyroid adenoma located in the mediastinum. A 66-year-old woman suffering from primary hyperparathyroidism had been followed-up on an outpatient basis for over 10 years. She suffered from persistent urolithiasis and osteopenia due to hypercalcemia. After technetium-99-sestamibi (99mTc-MIBI) scintigraphy revealed an ectopic adenoma in the superior mediastinum, thoracoscopic resection of the tumor was performed. Subsequently, her serum parathyroid hormone (PTH) level decreased dramatically and her serum calcium concentration was restored to normal. Two years following surgery, her serum PTH and Ca levels remain stable.
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Affiliation(s)
- Masashi Ishikawa
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Shin-Ichi Sumitomo
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Naoto Imamura
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Tomoki Nishida
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Katsutaka Mineura
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
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Martos-Martínez JM, Sacristán-Pérez C, Pérez-Andrés M, Durán-Muñoz-Cruzado VM, Pino-Díaz V, Padillo-Ruiz FJ. Prevertebral cervical approach: a pure endoscopic surgical technique for posterior mediastinum parathyroid adenomas. Surg Endosc 2016; 31:1930-1935. [PMID: 27553796 DOI: 10.1007/s00464-016-5197-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parathyroid gland mediastinal ectopia is an unusual but challenging condition in surgical management of hyperparathyroidism. Posterior mediastinum parathyroid ectopia is rare, and glands need to be removed either with a broad open cervical or thoracic approach. In recent years, several minimally invasive approaches to mediastinal parathyroid glands have been described, but for posterior mediastinum adenomas, proposed techniques are transthoracic. METHODS The aim of this paper is to describe, to our best knowledge for the first time, a standardized pure endoscopic cervical technique to approach posterior mediastinal parathyroid adenomas which we have used in three patients. RESULTS The technique was applied in three patients which excellent surgical, postoperative, and cosmetic results. CONCLUSIONS Endoscopic prevertebral approach is a feasible, sure and inexpensive standardized pure endoscopic cervical approach to posterior mediastinal parathyroid adenomas, which may result in a less aggressive surgical option when compared with thoracic approaches.
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Affiliation(s)
- Juan Manuel Martos-Martínez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain.
| | - Cristina Sacristán-Pérez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Marina Pérez-Andrés
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | | | - Verónica Pino-Díaz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Francisco Javier Padillo-Ruiz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
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Naik D, Jebasingh KF, Ramprasath, Roy GB, Paul MJ. Video Assisted Thoracoscopic Surgery (VATS) for Excision of an Ectopic Anterior Mediastinal Intra-Thymic Parathyroid Adenoma. J Clin Diagn Res 2016; 10:PD22-4. [PMID: 27504353 DOI: 10.7860/jcdr/2016/18108.8023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 11/24/2022]
Abstract
Ectopic anterior mediastinal parathyroid adenoma is a rare cause of Primary Hyperparathyroidism (PHPT). Imaging studies such as Technetium-99m ((99m)Tc) sestamibi parathyroid scan along with a Single Photon Emission Computerized Tomogram (SPECT), and contrast enhanced Computerized Tomogram (CT) of the neck and thorax can precisely localize the ectopic mediastinal parathyroid adenoma. We report a 40-year-old gentleman who presented with persistent pain in the right shoulder following trivial trauma. His biochemical investigations showed an elevated serum calcium of 11.6mg% (Normal: 8.3-10.4 mg%) along with an elevated iPTH of 1443 pg/ml (normal: 8-70 pg/ml) which were suggestive of primary hyperparathyroidism. The localization studies revealed an ectopic cystic parathyroid adenoma in the anterior mediastinum that was not accessible from the neck. He underwent a Video Assisted Thoracoscopic (VAT) excision procedure with normalization of serum calcium and an uncomplicated recovery. The VAT approach is a successful minimally invasive technique for mediastinal parathyroidectomy.
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Affiliation(s)
- Dukhabandhu Naik
- Associate Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College , Vellore, India
| | - Kumaradoss Felix Jebasingh
- Senior Registrar, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College , Vellore, India
| | - Ramprasath
- Assistant Professor, Department of Thoracic surgery, Christian Medical College , Vellore, India
| | - Gnanamuthu Birla Roy
- Professor, Department of Thoracic Surgery, Christian Medical College , Vellore, India
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Libánský P, Yershov D, Adámek S, Šimonek J, Fialová M, Kubinyi J, Lischke R. Video-assisted mediastinoscopic removal of ectopic parathyroid adenoma combined with standard cervical exploration. Eur Surg 2016. [DOI: 10.1007/s10353-016-0413-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siddiqi MS, Al Badai Y, Al Kemyani NA, Al Kindi AH. Combined transcervical and thoracoscopic mediastinal parathyroid adenoma resection. Asian Cardiovasc Thorac Ann 2016; 24:593-6. [PMID: 27206778 DOI: 10.1177/0218492316649296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The routine approach for excision of a parathyroid adenoma is transcervical, but this approach is inadequate when the gland is located in the mediastinum. Traditionally, these cases have required a sternotomy or thoracotomy. We used a combined transcervical and video-assisted thoracoscopic surgery approach to resect a parathyroid adenoma that extended to the middle mediastinum.
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Affiliation(s)
| | - Yahya Al Badai
- ENT Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser A Al Kemyani
- Cardiothoracic Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil H Al Kindi
- Cardiothoracic Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman
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33
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Bellantone R, Traini E, Raffaelli M, Lombardi CP. Surgical Technique in Reoperations. Updates Surg 2016. [DOI: 10.1007/978-88-470-5758-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yu MA, Yao L, Zhang L, Peng L, Zhuo L, Zhang Y, Li W, Lv MD. Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study. Int J Hyperthermia 2015; 32:180-6. [PMID: 26606889 DOI: 10.3109/02656736.2015.1101788] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Recurrent and persistent secondary hyperparathyroidism (SHPT) nodules have an incidence of 10-70% after surgery. The treatment of recurrent and persistent SHPT nodules is a challenge, and surgical resection of difficult-to-reach or post-operative adhesions often fails. PURPOSE The aim of this research was to study the safety and effectiveness of microwave ablation (MWA) for recurrent and persistent SHPT. MATERIALS AND METHODS This was a retrospective study of 11 patients enrolled with a total of 16 nodules, and MWA was employed to manage SHPT. The laboratory test results, including the intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels, improvement of SHPT-related symptoms after ablation, and complications during and after MWA were recorded and analysed. RESULTS After ablation the value of iPTH was markedly decreased from 1570 ± 1765 pg/mL to 287 ± 239 pg/mL 1 day after MWA (p < 0.05). The levels of serum calcium and phosphorus decreased from 2.51 ± 0.23 mmol/L to 2.06 ± 0.27 mmol/L (p < 0.001) and 1.80 ± 0.43 mmol/L to 1.48 ± 0.32 mmol/L (p < 0.05), respectively, 1 day after MWA. There was no significant difference in the ALP value before and after MWA (p > 0.05). The clinical symptoms, including ostalgia, pruritus, disability, and restless legs, improved after MWA. Minor complications and side effects encountered during or after MWA include haematoma (1/11, 9%), transient hoarseness (2/11, 18.2%), hypocalcemia (6/11, 54.5%). No major complication occurred. CONCLUSION MWA may be safe and effective to manage recurrent and persistent SHPT nodules; a definite conclusion needs to expand the sample size with a longer follow-up time.
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Affiliation(s)
- Ming-An Yu
- a Interventional Ultrasound Centre, China-Japan Friendship Hospital , Beijing
| | - Li Yao
- b Endoscopy Centre, China-Japan Friendship Hospital , Beijing
| | - Ling Zhang
- c Department of nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Lili Peng
- a Interventional Ultrasound Centre, China-Japan Friendship Hospital , Beijing
| | - Li Zhuo
- c Department of nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Yumei Zhang
- c Department of nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Wenge Li
- c Department of nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Ming-De Lv
- a Interventional Ultrasound Centre, China-Japan Friendship Hospital , Beijing
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Hu J, Ngiam KY, Parameswaran R. Mediastinal parathyroid adenomas and their surgical implications. Ann R Coll Surg Engl 2015; 97:259-61. [PMID: 26263931 PMCID: PMC4473861 DOI: 10.1308/003588415x14181254789088] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause of persistent hyperparathyroidism after surgery. A common site of the missed ectopic gland will be that in the mediastinum. However, with the increasing improvement in available imaging, it is likely that this can be diagnosed preoperatively. The surgical approach to the mediastinal parathyroid has also changed vastly over the last decade from maximally invasive to minimally invasive with minimal complications. We provide a review on the entity of mediastinal parathyroid adenomas and their surgical implications.
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Affiliation(s)
- Jesse Hu
- National University Hospital, Singapore
| | - KY Ngiam
- National University Hospital, Singapore
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Issoufou I, Belliraj L, Rabiou S, Ghalimi J, Rchachi M, Lakranbi M, Ajdi F, Ouadnouni Y, Smahi M. Intrathymic Parathyroid Adenoma. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/crcm.2015.48059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lu HI, Chou FF, Chi SY, Huang SC. Thoracoscopic Removal of Hypertrophic Mediastinal Parathyroid Glands in Recurrent Secondary Hyperparathyroidism. World J Surg 2014; 39:400-9. [DOI: 10.1007/s00268-014-2797-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim YS, Kim J, Shin S. Thoracoscopic removal of ectopic mediastinal parathyroid adenoma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:317-9. [PMID: 25207237 PMCID: PMC4157490 DOI: 10.5090/kjtcs.2014.47.3.317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/17/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
Abstract
Ectopic mediastinal parathyroid adenomas or hyperplasias account for up to 25% of primary hyperparathyroidism cases. Most abnormal parathyroid glands are found in the superior mediastinum within the thymus and can be removed through a cervical incision; however, a few of these glands are not accessible using standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy. However, recent advancement in video-assisted thoracic surgery techniques has decreased the need for sternotomy or thoracotomy to remove these ectopic parathyroid glands. Here, we report a successful case of video-assisted thoracoscopic removal of a mediastinal parathyroid adenoma.
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Affiliation(s)
- Young Su Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Daliakopoulos SI, Chatzoulis G, Lampridis S, Pantelidou V, Zografos O, Ioannidis K, Sapranidis M, Ploumis A. Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature. J Cardiothorac Surg 2014; 9:62. [PMID: 24685256 PMCID: PMC4230425 DOI: 10.1186/1749-8090-9-62] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/20/2014] [Indexed: 11/27/2022] Open
Abstract
Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.
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Affiliation(s)
- Stavros I Daliakopoulos
- Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - George Chatzoulis
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Varvara Pantelidou
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Omiros Zografos
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Konstantinos Ioannidis
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Michael Sapranidis
- Department of Endocrinology, Hippokration Hospital, Konstantinoupoleos 49, Thessaloniki Gr 546 42, Greece
| | - Avraam Ploumis
- Department of Orthopaedic Surgery and Rehabilitation, University Hospital of Ioannina, Stavrou Niarchou Avenue, Ioannina Gr 45 500, Greece
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Said SM, Cassivi SD, Allen MS, Deschamps C, Nichols FC, Shen KR, Wigle DA. Minimally invasive resection for mediastinal ectopic parathyroid glands. Ann Thorac Surg 2013; 96:1229-1233. [PMID: 23968765 DOI: 10.1016/j.athoracsur.2013.05.084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Sameh M Said
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark S Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Claude Deschamps
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
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Ismail M, Swierzy M, Ulrich M, Rückert J. Anwendung des daVinci-Robotersystems in der Thoraxchirurgie. Chirurg 2013; 84:643-50. [DOI: 10.1007/s00104-013-2502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Davoli F, Rena O, Pirondini E, Casadio C. Giant functioning mediastinal parathyroid cyst: an unusual cause of exertional dyspnea and mild dysphagia. Arch Bronconeumol 2013; 49:408-9. [PMID: 23542045 DOI: 10.1016/j.arbres.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/25/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation. Surg Today 2013; 44:533-9. [PMID: 23494068 DOI: 10.1007/s00595-013-0547-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Surgical removal of a mediastinal ectopic parathyroid is always challenging. We attempted to apply intraoperative radio-guided navigation for the minimally invasive focused removal of ectopic hyperparathyroid lesions in the mediastinum, and evaluated its significance. METHODS Five cases with ectopic mediastinal hyperfunctioning parathyroid were treated by intraoperative radio-guided navigation surgery. MIBI (methoxyisobutylisonitrile)-SPECT (single-photon emission computed tomography) was used to plan the surgical approach. (99m)Tc-MIBI (11.1 MBq/kg) was administered 2 h before surgery, and a handheld gamma probe was used intraoperatively to detect radioactivity in the lesion. RESULTS Two lesions found on the aortic arch were excised by left thoracoscopic resection. Two other lesions on the tracheal bifurcation were approached by right thoracotomy. We could remove two hidden adenomas by en bloc resection with the adjacent lymph nodes under radio-guidance. Another lesion, located at the ligamentum arteriosum, was excised with sternal division. Accumulations of radioactivity were identified in all lesions removed, with decreased radioactivity in the surgical field. CONCLUSIONS Intraoperative radio-guided navigation is a useful tool for the focused removal of an ectopic mediastinal parathyroid by providing instant feedback to help guide the surgeon, while also providing precise localization of lesions.
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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 2011; 36:1327-34. [DOI: 10.1007/s00268-011-1404-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Optimizing the minimally invasive approach to mediastinal parathyroid adenomas. Ann Thorac Surg 2011; 92:1012-7. [PMID: 21871292 DOI: 10.1016/j.athoracsur.2011.04.091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 04/17/2011] [Accepted: 04/22/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with refractory hyperparathyroidism after neck exploration may have a mediastinal parathyroid gland that has not been identified reliably with a single radiologic study. We report 17 patients who underwent minimally invasive resection for mediastinal parathyroid adenomas after confirmatory multipoint radiologic imaging. METHODS Fifteen patients underwent thoracoscopic procedures and 2 patients underwent mediastinoscopic procedures for resection of suspected mediastinal parathyroid adenoma. Preoperative localizing studies included sestamibi scan, computed tomography scan of the neck and chest, and selective venous sampling of parathyroid hormone levels. Once a mediastinal location was determined, thoracoscopic or mediastinoscopic resection was performed. Successful removal of parathyroid tissue was confirmed with a 50% or greater reduction in intraoperative parathyroid hormone levels. RESULTS Parathyroid adenoma was resected in 88% of patients after the operation. The cure rate was 100% in patients with two or more concordant studies locating parathyroid tissue in the mediastinum and 60% in those with one positive study. The thoracostomy tube was removed on median postoperative day 1 (range, 0 to 2 days). Median hospital stay was 3 days (range, 2 to 7 days). The most common complication was temporary hypocalcemia, which occurred in 18% of patients. CONCLUSIONS Minimally invasive parathyroidectomy is an effective treatment of hyperparathyroidism caused by mediastinal parathyroid tissue. Targeted exploration depends on the guidance of preoperative localization studies and measurement of intraoperative parathyroid hormone levels to verify successful resection. Selective venous sampling and high-resolution computed tomography scanning can be helpful in patients with negative sestamibi scans.
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Van Dessel E, Hendriks JMH, Lauwers P, Ysebaert D, Ruyssers N, Van Schil PEY. Mediastinal Parathyroidectomy with the da Vinci Robot. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Els Van Dessel
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | | | - Patrick Lauwers
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - Dirk Ysebaert
- Hepatobi-liary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
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Mediastinal Parathyroidectomy with the da Vinci Robot. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:262-4. [PMID: 22437986 DOI: 10.1097/imi.0b013e31822c5a4a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mediastinal parathyroid glands are often located in a position which is inaccessible through a cervical approach. Because of the significant morbidity of open surgery, the need for minimal invasive approaches is high. More recently, robotic systems have been introduced to refine the dissection and optimize the view in the mediastinal region. We present two cases. The first case is a 34-year-old woman who was diagnosed with primary hyperparathyroidism. Because a bilateral neck dissection disclosed no parathyroid adenoma, we performed a parathyroid sestamibi scan and computed tomographic scan of neck and mediastinum to look for aberrant parathyroid glands. Both showed a parathyroid adenoma in the mediastinum on the left side. The second case is a 66-year-old man. A sestamibi scan showed a parathyroid adenoma of 3 cm in the superior mediastinum which was confirmed by and computed tomographic scan. In both cases, we performed a parathyroidectomy with the da Vinci robotic system through a left-sided approach. Three thoracoports were inserted around the mammary gland for the robot and a fourth auxiliary port was positioned in between. Single-lung ventilation was installed, and the mediastinum was entered by opening the parietal pleura along the left phrenic nerve. The upper margin for dissection was the left brachiocephalic vein that was followed until the right pleura. All the tissue in front of the pericardium was dissected en bloc. The sinking test of the nodule and a preoperative frozen section analysis confirmed the diagnosis of parathyroid adenoma, which was also proven by rapid parathyroid hormone analysis. The resection of a parathyroid adenoma from the aortopulmonary window represents an ideal case for robotic surgery.
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Iacobone M, Mondi I, Viel G, Citton M, Tropea S, Frego M, Favia G. The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients. Langenbecks Arch Surg 2010; 395:947-53. [PMID: 20623135 DOI: 10.1007/s00423-010-0678-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/23/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Parathyroidectomy for ectopic mediastinal hyperfunctioning glands could be performed by transcervical approach, sternotomy, thoracotomy, and recently by thoracoscopic and mediastinoscopic approaches. This study was aimed to analyze the results of traditional and video-assisted parathyroidectomy for mediastinal benign hyperfunctioning glands. METHODS Fifty-one upper mediastinal exploration by a conventional cervicotomy, 12 by video-assisted approaches (two thoracoscopy and 10 transcervical mediastinoscopy) and six by sternotomy were performed in 63 patients with primary hyperparathyroidism. RESULTS Video-assisted and sternotomic parathyroid explorations achieved biochemical cure in all cases; following conventional transcervical mediastinal exploration, a persistent hyperparathyroidism occurred in 11.8% of patients, who were subsequently cured by sternotomic approach. No complications occurred after video-assisted parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomic and conventional cervicotomic approaches. Postoperative pain and hospital stay were significantly increased following sternotomy; patient's subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotomic approaches. CONCLUSIONS Conventional cervicotomic parathyroidectomy may achieve satisfactory results, especially for upper mediastinal glands. Sternotomic approaches are effective, but should be limited because of invasiveness and increased morbidity. In case of deep and lower hyperfunctioning mediastinal parathyroids, video-assisted approaches represent a less invasive, effective, and safe alternative and might be the technique of choice.
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Affiliation(s)
- Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
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Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg 2010; 251:717-21. [PMID: 19858697 DOI: 10.1097/sla.0b013e3181c1cfb0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To retrospectively evaluate the feasibility of thoracoscopic removal of mediastinal parathyroids. SUMMARY BACKGROUND DATA Mediastinal exploration to resect ectopic parathyroid(s) is needed in approximately 2% of cases in hyperparathyroidism. Recent advances in thoracoscopic surgery allow for a minimally invasive treatment. METHODS From 1999 through 2007, 13 patients affected by primary hyperparathyroidism (11 females, mean age 60 years, range: 22-88) underwent thoracoscopic removal of mediastinal parathyroids. Scintigraphy produced positive results in 11 of 13 cases, computed tomography scan in 9 of 10, parathyroid hormone venous sampling in 10 of 10 patients, and magnetic resonance imaging in 5 of 7. Right thoracoscopic access was used in 9 patients, left in 4. Postoperative outcome was analyzed. RESULTS Thoracoscopy enabled retrieval of mediastinal parathyroids in 10 of 13 (78%) cases. Mean operating time was 92 minutes (range: 50-240). One procedure (8%) was converted. No perioperative deaths/major complications occurred. Mild complications occurred in 2 of 13 (15%) patients (pneumothorax/pneumonia, transient recurrent nerve palsy). Mean hospital stay was 4.7 days (range: 2-15). At a mean follow-up of 73 months (range: 16-105), parathyroid hormone and calcium venous concentrations were high in 3 patients. Unsuccessful procedures were related to doubtful or non-concordant preoperative localization. CONCLUSIONS The thoracoscopic approach for mediastinal parathyroidectomy is feasible and safe. An accurate preoperative work-up should be standardized to avoid useless procedures. In case of negative preoperative localization of the abnormal gland, thoracoscopy should not be adopted as a diagnostic tool.
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Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism. Eur J Nucl Med Mol Imaging 2009; 37:623-34. [DOI: 10.1007/s00259-009-1313-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
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