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      Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma

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          Abstract

          Background

          Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT). Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS). We present our experience with the novel use of Video-Assisted Mediastinoscopy (VAM) for resection of ectopic mediastinal parathyroid glands.

          Case presentation

          4 patients underwent VAM for removal of an ectopic intramediastinal parathyroid gland. All of them had at least one previous unsuccessful neck exploration.

          In all cases histology confirmed complete resection of ectopic parathyroid glands (3 parathyroid adenomas and one parathyroid hyperplasia). Two of the patients required a partial sternal split to facilitate exploration.

          Conclusion

          The cervical approach for resection of ectopic parathyroid adenomas is frequently unsuccessful. Previously, the standard surgical approach in such cases was sternotomy and exploration of the mediastinum. Recently, a number of less invasive modalities have been introduced.

          We found that VAM has several advantages. It has a short theatre time does not require a complex anaesthetic and is performed with the patient in classic supine position utilising often a previous cervical scar with good cosmetic results. It offers a short hospital stay; it is cost effective with minimal use of fancy and pricy consumables with a comfortable incision and no violation of the pleural space.

          Additionally the use of digital Video imaging has increased the sensitivity of the mediastinoscopy and has added safety and confidence in performing a detailed mediastinal exploration with an additional great training value as well.

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          Most cited references 6

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          Thoracoscopic resection of ectopic parathyroid glands.

          The vast majority of parathyroid glands in hyperparathyroidism can be resected through a cervical approach. In approximately 2% of the cases, the ectopic gland is in the mediastinum in a location that requires a thoracic approach. We report 7 such cases that were resected using video-assisted thoracic surgery to avoid the need for an open surgical procedure. All glands were successfully identified preoperatively and subsequently resected. Hospital stay averaged less than 3 days with only one minor complication. Ectopic mediastinal parathyroid glands may be safely and accurately resected using video-assisted thoracic surgery to avoid open approaches.
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            Intraoperative radioguided thoracoscopic removal of ectopic parathyroid adenoma.

            Twenty-five percent of primary hyperparathyroidism is caused by ectopic mediastinal parathyroid glands, with 2% of these not accessible to standard cervical surgical approaches. Advancement in video-assisted thoracoscopic surgical techniques has decreased the need for sternotomy to successfully remove these ectopic glands. The thoracoscopic approach, however, is limited by the surgeon's inability to always accurately visualize ectopic glands. Intraoperative radionuclide-guided dissection, using a thoracoscopic approach, provides a novel adjunct to the removal of occult ectopic parathyroid glands. We report a case of an occult ectopic parathyroid adenoma removed thoracoscopically using an intraoperative handheld gamma probe.
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              Ectopic mediastinal parathyroid adenoma

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                Author and article information

                Journal
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central
                1749-8090
                2007
                15 October 2007
                : 2
                : 41
                Affiliations
                [1 ]Department of Thoracic Surgery, St. James's University Hospital, Leeds LS9 7TF, UK
                [2 ]Department of Breast and Endocrine Surgery, St. James's University Hospital, Leeds LS9 7TF, UK
                Article
                1749-8090-2-41
                10.1186/1749-8090-2-41
                2146999
                17937802
                Copyright © 2007 Tcherveniakov et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Surgery

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