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Ann Thorac Surg. 2013 Oct;96(4):1229-33. doi: 10.1016/j.athoracsur.2013.05.084. Epub 2013 Aug 20.

Minimally invasive resection for mediastinal ectopic parathyroid glands.

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1
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.

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.

KEYWORDS:

13

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