Endoscopic Total Parathyroidectomy in an Adolescent

Abstract

ABSTRACT

Background:

The first endoscopic parathyroidectomy was performed by Gagner in 1995. Since then, a number of other cases reporting the feasibility of the procedure in adults have been reported. To our knowledge, this type of intervention has not been previously reported in a child.

Method:

A 14-year-old boy suffering from end-stage renal failure with progressive osteodystrophy and uncontrolled hypercalcemia underwent an endoscopic total parathyroidectomy. A cervicoscopic exploration of the neck was performed by pneumodissection using a 4-mm 25° telescope in the suprasternal notch and two 3-mm ports for pediatric endoscopic instruments, allowing the four parathyroid glands to be removed.

Results:

There was no peroperative or postoperative hypercapnia. Emphysema was mild and disappeared within 24 hours. The patient suffered no postoperative complications. Postoperative pain could be controlled easily with paracetamol and mefenamic acid, which were required until the second postoperative day. Three days postoperatively, the serum concentration of calcium had stabilized, and the patient was discharged.

Conclusions:

This initial experience shows that endoscopic parathyroidectomy can be performed in children as safely and reliably as in adults. It provides the surgeon a minimally invasive procedure and at least as good a view of the parathyroids as the open approach.