Role of Thoracic Surgery in parathyroid surgery

• Main Authors: Marcelo F. JIMÉNEZ-LÓPEZ, María Teresa GÓMEZ-HERNÁNDEZ
• Format: Article
• Language: Spanish
• Published: Ediciones Universidad de Salamanca 2020-07-01
• Series: Revista ORL
• Subjects: paratiroides ectópica; mediastino; paratiroides mediastínica; hiperparatiroidismo; cirugía torácica; adenoma paratiroideo
• Online Access: https://revistas.usal.es/index.php/2444-7986/article/view/21593
• ISSN: 2444-7986

Introduction and objective: The prevalence of ectopic parathyroids ranges from 6.3% to 26% in patients undergoing surgery due to hyperparathyroidism and mediastinal exploration is necessary in about 1-2% of patients with ectopic parathyroid. The objective of this article is to describe the particularities of surgical treatment of mediastinal parathyroids. Synthesis: Preoperative localization of ectopic parathyroids is essential to ensure the success of the intervention; dual phase scintigraphy with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) is considered the gold standard technique for its location. Intraoperative radioguided navigation with a gamma probe and intraoperative monitoring of PTH are useful for reducing surgical time and avoiding unnecessary re-examinations. Minimally invasive approaches (VATS or robotic surgery) for the exploration and removal of mediastinal lesions offer advantages over conventional open approaches such as magnification and better vision of structures and maneuverability. Conclusions: The success of surgical removal of ectopic parathyroids is based on the appropriate preoperative location. Radio-guided navigation with gamma probe and intraoperative PTH monitoring are useful to ensure adequate parathyroid resection. Minimally invasive approaches (VATS or robotic surgery) have reduced the need for sternotomy or thoracotomy.