Transoral Endoscopic Total Parathyroidectomy in Renal Hyperparathyroidism Patient

Abstract

Abstract

Introduction:

The standard technique of parathyroidectomy in renal hyperparathyroidism patient is open surgery with bilateral cervical exploration. In the present, there are various different minimal invasive surgeries for parathyroidectomy such as minimally invasive open parathyroidectomy (MIP),^1–4 which can be performed in the ambulatory setting or endoscopic parathyroidectomy involving gas and gasless approaches.^5–10 The latest technique for endoscopic parathyroidectomy is the transoral approach.^11–15 This video shows our techniques of transoral total parathyroidectomy (step by step) via vestibular approach in Police General Hospital, Thailand.

Patient and Methods:

The patient is a 49-year-old male who had symptomatic renal hyperparathyroidism. He was preoperatively found to have high blood level of parathyroid hormone of 1617 pg/mL (15–65) and corrected calcium of 10.3 mg/dL (8.5–10.5). He had severe bone pain and was fully treated by the nephrologist. The incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the mid-oral vestibule with two 5-mm trocars laterally. Intraoperative parathyroid hormone (IOPTH) level and frozen section were conducted. Parathyroid autotransplantation was performed at the nondialyzed forearm.

Results:

Four glands of parathyroid were resected and confirmed by frozen section. The IOPTH level was 72 pg/mL (15–65). The operative time was 177 minutes with 15 mL blood loss. The length of hospital stay was 93 hours. The final pathology report showed all four parathyroid hyperplasias. Postoperative parathyroid hormone level at day 30 was 87 pg/mL (15–65) and corrected calcium of 9.2 mg/dL (8.5–10.5). There were no intraoperative complications or any postoperative complications (mental nerve injury, hoarseness, hematoma, seroma, infection) in this patient.

Conclusions:

The endoscopic total parathyroidectomy in renal hyperparathyroidism patient is feasible and safe, but it takes longer operative time and hospital stay when compared with standard open surgery or MIP.

No competing financial interests exist.

Runtime of video: 9 mins 5 secs