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Park D, Cho H, Lee E, Oh MY, Kim K, Chai YJ, Kim HY. Feasibility and Safety of transoral robotic parathyroidectomy: Initial experience with a new approach for parathyroid surgery. Asian J Surg 2024:S1015-9584(24)01535-5. [PMID: 39068075 DOI: 10.1016/j.asjsur.2024.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/05/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND We present the initial outcomes of transoral robotic parathyroidectomy (TORP) using the transoral vestibular approach in patients with primary hyperparathyroidism (PHPT). METHOD A retrospective case series analysis was performed on patients diagnosed with PHPT between October 2016 and July 2019 who underwent transoral robotic surgery for parathyroidectomy. RESULTS Thirteen patients (five males and eight females) successfully underwent TORP at our institution from October 2016 to July 2019. Eight patients underwent TORP alone, and five underwent TORP combined with transoral robotic thyroidectomy for papillary thyroid carcinoma. No intra- or postoperative complications were observed. Serum levels of parathyroid hormone, total calcium, and ionized calcium decreased to normal postoperatively and continued to decrease during the follow-up period. CONCLUSION This study suggests that TORP holds promise for the treatment of patients with PHPT with the advantages of the robotic procedure, including dynamic visualization and meticulous dissection.
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Affiliation(s)
- Dawon Park
- Department of Surgery, Korea University Anam Hospital, Republic of Korea
| | - Hyewon Cho
- Korea University Medical Center, Seoul, Republic of Korea
| | - Eunbee Lee
- Korea University Medical Center, Seoul, Republic of Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University Anam Hospital, Republic of Korea.
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Hua T, Lou J, Zhu Y, Luo Y, Zhang H, Yang J. Endoscopic total parathyroidectomy via anterior chest approach with forearm autotransplantation for secondary hyperparathyroidism: a comparison of surgical results with open total parathyroidectomy with autotransplantation. Front Oncol 2023; 13:1137278. [PMID: 37197419 PMCID: PMC10183594 DOI: 10.3389/fonc.2023.1137278] [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: 01/04/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Objective This paper aimed to evaluate the clinical value of performing an endoscopic total parathyroidectomy through anterior chest approach with autotransplantation (EACtPTx+AT) in treating secondary hyperparathyroidism (SHPT) to summarize and share the clinical experience. Methods 24 patients with SHPT were retrospectively analyzed:11 patients underwent open total parathyroidectomy with autotransplantation (OtPTx+AT Group) and 13 patients underwent endoscopic parathyroidectomy through anterior chest approach with autotransplantation (EACtPTx+AT Group). Comparing the two groups regarding the following factors: (1) operating conditions, such as the blood loss during the operation, the length of time spent on the operating table, the number of parathyroid glands removed, postoperative drainage volume and hospital stay. (2) clinical efficacy, parathyroid hormone (PTH) and serum calcium (Ca) levels. (3) postoperative complications. Results First, there were no significant differences in the number of parathyroid gland resection, operation time, intraoperative blood loss and hospital stay between the two groups. While there were significant differences in postoperative drainage volume between the two groups. Second, the two groups preoperative PTH and preoperative serum calcium decreased significantly compared with those of the two groups after surgery and there was a statistically significant difference. Thirdly, there was no postoperative bleeding, hoarseness or choking in the two groups and no conversion to open surgery case in EACtPTx+AT group. Conclusion Endoscopic treatment of SHPT using the anterior chest approach with forearm autotransplantation significantly improves clinical symptoms and lowers levels of PTH and serum calcium after the operation. The results confirm the operation's safety and effectiveness.
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Affiliation(s)
- Tebo Hua
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
- *Correspondence: Tebo Hua,
| | - Jinfeng Lou
- Department of Anesthesiology, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
| | - Ye Zhu
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
| | - Yong Luo
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
| | - Hai Zhang
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
| | - Jiahui Yang
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, China
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Liu S, Li M, Pang H, Zuo R, Kong L, Wang Z, Li W, Xia Z, Wang D, Xu L. Clinical application of 18F-FCH PET/CT in the diagnosis and treatment of hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1100056. [PMID: 37113486 PMCID: PMC10126393 DOI: 10.3389/fendo.2023.1100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Objective We evaluated the difference in parathyroid visualization on 18F-FCH PET/CT images obtained at 5 and 60 min, and quantitatively analyzed the mode of FCH uptake at different time points, to determine the best imaging time for FCH PET/CT. Methods This retrospective study included 73 patients with hyperparathyroidism (HPT) who underwent 18F-FCH PET/CT imaging between December 2017 and December 2021. The diagnostic efficiency of 5- and 60-min dual time point imaging for the diagnosis of hyperparathyroidism and parathyroid adenoma and hyperplasia, were compared using visual and quantitative analyses. Results Dual-time 18F-FCH PET/CT imaging visual analysis had diagnostic value for HPT. The receiver operating characteristic curve of PET/CT quantitative parameters for the diagnosis of HPT and lesions showed that the parathyroid/thyroid SUVmax ratio for 60-min imaging had a higher sensitivity and specificity (based on patient, sensitivity: 90.90% and specificity: 85.71%; based on focus, sensitivity: 83.06% and specificity: 85.71%) compared to that for 5-min imaging. PET/CT quantitative parameters can distinguish parathyroid adenoma and hyperplasia. The 60-min parathyroid SUVmax value had the highest diagnostic value (cutoff: 3.945; area under the curve: 0.783). Conclusion The quantitative parameters of 60min 18F-FCH PET/CT have more advantages in aiding in the pathologica diagnosis and clinical treatment of HPT.
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Affiliation(s)
- Shuang Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengdan Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingquan Kong
- Department of Breast Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenbo Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhu Xia
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Lu Xu,
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Jacquet-Francillon N, Morelec I, Germain N, Prades JM, Habouzit V, Mariat C, Bonnefoy PB, Prevot N. Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study). Front Med (Lausanne) 2022; 9:956580. [PMID: 35983092 PMCID: PMC9380568 DOI: 10.3389/fmed.2022.956580] [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: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective [18F]Fluorocholine positron emission tomography/computed tomography (PET/CT) is used frequently in addition to [99mTc]Tc-Sestamibi scintigraphy and ultrasonography for the location of hyperfunctioning parathyroid glands. The aim of this study is to evaluate the performance of quantitative criteria in [18F]fluorocholine PET/CT for localization of hyperfunctioning parathyroid glands. The secondary objective is to highlight a correlation between the detection rate of [18F]fluorocholine PET/CT and serum parathyroid hormone (PTH) level. Materials and methods In two academic centers, we retrospectively included patients with biological hyperparathyroidism (HPT) and who had [18F]fluorocholine PET/CT. After a visual analysis, to measure the overall performance of [18F]fluorocholine PET/CT, a blind reading was carried out with standardized measurements of maximum standardized uptake value (SUVmax), liver ratio, thyroid ratio, and size ratio. We analyzed the quantitative criteria of [18F]fluorocholine PET/CT compared to the histological results, in particular to identify differences between adenomas and hyperplasias. We compared the performance of each quantitative criterion to the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F]fluorocholine PET/CT. The detection rate of hyperfunctioning parathyroid glands was calculated in subgroups of serum PTH level. Results The quantitative criteria in [18F]fluorocholine PET/CT were measured for 120 patients (135 lesions). The areas under the receiver operating characteristic (ROC) curve representing SUVmax and liver ratio were significantly increased. The optimal cut-off values represented by the maximum Youden index was >4.12 for SUVmax and >27.4 for liver ratio. Beyond certain threshold values of SUVmax (>4.12) or liver ratio (>38.1), all the lesions were histologically proven adenomas. SUVmax and liver ratio were significantly higher for adenomas than for hyperplasias and differential diagnosis (p = 0.0085 and p = 0.0002). The positivity of [18F]fluorocholine PET/CT was correlated with PTH level. Detection rates were 55.56, 75.56, and 87.5%, respectively, for serum PTH < 70, 70 to 120, and >120 ng/ml. Conclusion Semi-quantitative measurements (SUVmax and liver ratio) should be considered as additional tools in interpretation of [18F]fluorocholine PET/CT. These quantitative parameters have lower overall performance but higher specificity than overall visual analysis in identifying an adenoma. Above certain threshold values, all lesions are adenomas. [18F]fluorocholine PET/CT confirms excellent performance for the detection of hyperfunctional parathyroids. For serum PTH levels < 70 ng/ml, the detection rate of [18F]fluorocholine PET/CT is strongly decreased.
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Affiliation(s)
- Nicolas Jacquet-Francillon
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- *Correspondence: Nicolas Jacquet-Francillon,
| | - Isabelle Morelec
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Natacha Germain
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Saint-Étienne, France
- Eating Disorders, Addictions and Extreme Bodyweight Research Group (TAPE) EA 7423, Université Jean Monnet, Saint-Étienne, France
| | - Jean-Michel Prades
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Saint-Étienne, Saint-Étienne, France
- Laboratory of Human Anatomy, Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France
| | - Vincent Habouzit
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal Transplantation, Hôpital Nord, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Jean Monnet University, Université de Lyon, Saint-Étienne, France
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP, EA 3065, University of Jean Monnet and Université de Lyon, Saint-Étienne, France
| | - Pierre-Benoit Bonnefoy
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Nathalie Prevot
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, Univ Lyon, Univ Saint-Etienne, Saint-Etienne, France
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Risk Factors of Redo Surgery After Unilateral Focused Parathyroidectomy: Conclusions From a Comprehensive Nationwide Database of 13,247 Interventions Over 6 Years. Ann Surg 2020; 272:801-806. [PMID: 32833757 DOI: 10.1097/sla.0000000000004269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical removal of hyperfunctional parathyroid gland is the definitive treatment for primary hyperparathyroidism (pHPT). Postoperative follow-up shows variability in persistent/recurrent disease rate throughout different centers. OBJECTIVE To evaluate the incidence of redo surgery after targeted parathyroidectomy for pHPT. METHODS We performed a nationwide retrospective cohort study on the "Programme de Medicalisation des Systemes d'Information," the French administrative database that collects information on all healthcare facilities' discharges. We extracted data from 2009 to 2018 for all patients who underwent parathyroidectomy for pHPT between January 2011 to December 2016. The primary outcome was the reoperation rate within 2 years since first surgery. Patients who had a first attempt of surgery within the previous 24 months, familial hyperparathyroidism, multiglandular disease, and renal failure were excluded. Results were adjusted according to sex and the Elixhauser Comorbidity Index. Operative volume thresholds to define high-volume centers were achieved by the Chi-Squared Automatic Interaction Detector method. RESULTS In the study period, 13,247 patients (median age 63, F/M=3.6) had a focused parathyroidectomy by open (88.7%) or endoscopic approach. Need of remedial surgery was 2.8% at 2 years. In multivariate analysis, factors predicting redo surgery were: cardiac history (P=0.008), obesity (P=0.048), endoscopic approach (P=0.005), and low-volume center (P<0.001). We evaluated that an annual caseload of 31 parathyroidectomies was the best threshold to discriminate high-volume centers and carries the lowest morbidity/failure rate. CONCLUSION Although focused parathyroidectomy represents a standardized operation, cure rate is strongly associated with annual hospital caseload, type of procedure (endoscopic), and patients' features (obesity, cardiac history). Patients with risk factors for redo surgery should be considered for an open surgery in a high-volume center.
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Successful Modified Transoral Endoscopic Parathyroidectomy Vestibular Approach For Secondary Hyperparathyroidism With Ectopic Mediastinal Glands. Surg Laparosc Endosc Percutan Tech 2019; 29:e88-e93. [DOI: 10.1097/sle.0000000000000727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sasanakietkul T, Jitpratoom P, Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc 2016; 31:3755-3763. [PMID: 28032220 DOI: 10.1007/s00464-016-5397-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/15/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery developed for neck surgery become increasing popular. Herein, an innovative transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT) and renal hyperparathyroidism (rHPT). METHODS Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars laterally. The subplatysmal space was created down to the sternal notch, and carbon dioxide pressure was insufflated at 6 mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathyroid hormone level and frozen section were conducted. Autotransplantation of the parathyroid gland was performed at the non-dominant forearm in an rHPT patient. RESULTS From March 2015 to June 2016, TOEPVA was successfully performed in 12 patients (six PHPT and six rHPT). The mean operative time for parathyroidectomy in PHPT patients was 107.5 min (range 88-127) and 185.8 min in rHPT patients (range 155-214). One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT and the rHPT group at 30 days was 36.38 ± 7.1 pg/mL (range 27.7-46.5) and 60.35 ± 15.94 pg/mL (range 38.7-87.2), respectively. The postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found. CONCLUSIONS TOEPVA is a feasible, safe, and reasonable surgical option for patients with hyperparathyroidism, especially those with cosmetic concerns.
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Affiliation(s)
- Thanyawat Sasanakietkul
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pornpeera Jitpratoom
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
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Endoscopic surgery of the parathyroid glands: methods and principles. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:157-60. [PMID: 23562229 DOI: 10.1016/j.anorl.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/22/2012] [Accepted: 11/26/2012] [Indexed: 11/23/2022]
Abstract
Targeted endoscopic parathyroidectomy without gas insufflation is a relatively non-invasive means of discovering and resecting parathyroid adenomas in sporadic primary hyperparathyroidism. This standardized technique depends on the quality of the preoperative imaging: cervical ultrasound and sestamibi scintigraphy, and can be optimized by preoperative insertion of an ultrasound-guided "harpoon" and rapid peroperative parathyroid hormone analysis. Failure rates range between 1.7% and 4%.
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Miccoli P, Materazzi G, Baggiani A, Miccoli M. Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: a 2011 update. J Endocrinol Invest 2011; 34:473-80. [PMID: 21427526 DOI: 10.1007/bf03346715] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thyroid surgery during the last century was characterized by a development of Kocher's concepts: through a relentless work of surgeons from all over the world thyroidectomy reached a standard of quality in terms of overall results which was unimaginable in the first half of the XX century. The flattering data collected in the literature until the 90's were all concordant in assuming that there would be little space for a real improvement in the quality standard of thyroid surgery. The introduction of laparoscopic surgery, though, changed very quickly the attitude of surgeons towards their operative behavior and countless new mini-invasive techniques were soon proposed for almost any field of surgery. In 1994, Gagner published the first series of laparoscopic adrenalectomies. Soon after, parathyroid adenomas seemed to offer an ideal field of application of these new surgical concepts. The first report of an endoscopic parathyroidectomy was in 1996. One year later other videoscopic procedures were described whose results seemed quite encouraging so as to push surgeons to try the same access and the same technique also for operations on thyroid. During the following decade several endoscopic or video-assisted approaches were proposed for the removal of thyroid gland. This paper aims to evaluate the results of minimally invasive thyroid and parathyroid surgery through an extensive review of the literature, in particular as far as minimally invasive video-assisted thyroidectomy is concerned.
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Affiliation(s)
- P Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy.
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