Video-assisted endocrine neck surgery: state of the art

Assessment of the Educational Quality, Accuracy, and Transparency of WebSurg Videos on Minimally Invasive Video-Assisted Parathyroidectomy

Background

The internet has changed the way both physicians and patients search for health information. WebSurg® is a valuable source of information that informs surgeons about new technologies and techniques and aims to promote quality, safety, and patient-centered care. In this study, our aim is to evaluate the popularity, quality, transparency, and accuracy of videos about minimally invasive video-assisted parathyroidectomy (MIVAP).

Materials and methods

A total of 31 videos related to MIVAP returned by the WebSurg® search engine in response to the keywords “MIVAP”, “video assisted parathyroidectomy’’, and “minimally invasive parathyroidectomy’’ were included in this study. Videos were evaluated in terms of time since upload, run time, country, academic degree, and the number of views and likes. The popularity of videos was determined by the video power index (VPI) formula. The DISCERN questionnaire score (DISCERNqs), global quality score (GQSc), and Journal of American Medical Association benchmark criteria (JAMABC) scoring systems were used to analyze WebSurg® videos for reliability and quality.

Results

The academic degree of the members was MD in 90.32% of uploaded videos. Forty-eight point thirty-eight percent (48.38%) of the videos were uploaded by members from France. There was no significant difference between the DISCERNqs, JAMABC, GQSc, and MIVAP scoring system (MIVAP-SS) scores in terms of academic degree and country. A statistically significant negative correlation was found between the time since upload and the VPI score (r=-0.683, p<0.001). The run time was positively correlated with the DISCERNqs, JAMABC, GQSc, and MIVAP-SS scores (p=0.003, p=0.002, p=0.003, p<0.001, respectively). For the MIVAP-SS score, the Spearman correlation analysis demonstrated a statistically significant positive correlation with VPI, DISCERNqs, JAMABC, and GQSc (p<0.05).

Conclusion

Videos about MIVAP are helpful for surgeons to learn the procedure step-by-step before the surgery they will be performing but still below the expected quality. It is recommended to use MIVAP-SS points, which is a novel scoring system, to ensure standardization and improve quality.

Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration

Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, P < 2.2 × 10^-16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, P = 3.1 × 10^-15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan (P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy (P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.

The role of narrow-band imaging in parathyroid surgery: a preliminary evaluation in five parathyroid adenoma cases

BACKGROUND

Narrow-band imaging uses selective haemoglobin light absorption to emphasise vascular visualisation and capillary networks.

OBJECTIVE

This study aimed to evaluate the application of this technique to parathyroid surgery.

METHOD

This preliminary evaluation was carried out on five consecutive patients with single parathyroid adenoma being considered for minimally invasive video-assisted parathyroidectomy. The adenomas were checked for narrow-band imaging vascular patterns. Minimally invasive video-assisted parathyroidectomy was then carried out in accordance with our standard protocol.

RESULTS

In four out of the five cases, narrow-band imaging integrated the white endoscopic light and direct vision, but in one case narrow-band imaging allowed distinction between the hidden neoplastic tissue and the surrounding structures thanks to the different vascular patterns.

CONCLUSION

Narrow-band imaging was helpful in properly identifying adenoma. It is suggested that this technique be considered as a means for surgeons to improve their confidence in selected surgical treatments and to improve treatment quality.