Video-Assisted Thoracoscopic Parathyroidectomy for an Ectopic Parathyroid Adenoma

Abstract

Abstract

Background:

Ectopic mediastinal parathyroid glands are rare (1.4% of ectopic parathyroid adenomas in patients who underwent investigation for primary hyperparathyroidism). ¹ Most of them (98%–99%) can be resected through a cervical approach if localized in the thymus and thoracic approaches are restricted to adenomas situated lower in the mediastinum. ² Video-assisted thoracoscopic surgery (VATS) parathyroidectomy is a treatment option to remove these glands, avoiding the complications and high morbidity of a sternotomy.^2,3

Methods:

We are presenting a VATS parathyroidectomy in a 64-year-old patient with primary hyperparathyroidism and ectopic (mediastinal) parathyroid adenoma.

Results:

A 64-year-old lady with no significant medical history was referred to our department for treatment of primary hyperparathyroidism. The patient was symptomatic (bone and muscle pains, fatigue, and mood changes), no kidney stones, or osteoporosis. Biochemistry showed elevated serum calcium (2.95 nmol/L) and parathyroid hormone (38 pmol/L). Ultrasound scan was negative and ^99mTc sestamibi scintigraphy showed a 3-cm mediastinal parathyroid adenoma. The patient underwent VATS parathyroidectomy with the patient in supine position and single lung ventilation. Three ports (10/5/10 mm) were inserted into the fifth to sixth right intercostal space. Important anatomical landmarks have been identified before starting the dissection. After the incision of the parietal pleura, the adenoma was identified posterior to the esophagus at the level of the aortic arch. Careful dissection of the adenoma was performed with monopolar electrocautery, preserving the capsule at any time. Vascular supply of the parathyroid gland was controlled with metal clips. Parathyroid adenoma was removed in an endobag. Postoperative course was uneventful and the patient was discharged on postoperative day 2. Histology analysis confirmed a parathyroid adenoma (weight 3.3 g, size 30/18/12 mm). The patient was normocalcemic for 6 months.

Conclusion:

VATS parathyroidectomy is safe and feasible as the treatment modality of choice to remove enlarged parathyroid adenomas from the lower mediastinum. It should be considered where expertise is available (thoracic/cardiac and endocrine surgeon).

There is no conflict of interest in connection with this video. The video was performed by the authors and recorded in our Endocrine Surgery Department. We do not have any commercial associations connected to this video.

Runtime of video: 9 mins 48 secs

Presented at the 7th Symposium of European Society of Endocrine Surgeons, How I Do it - Video Session, April 2017, in Oxford, United Kingdom.