Abstract
Abstract
Background:
Focused parathyroidectomy evolves the preferable surgical policy for primary hyperparathyroidism (PHPT).1–3 Transoral endoscopic vestibular approach furnishes a scarless choice of minimal invasive parathyroidectomy. Preoperative technetium-99m sestamibi (Tc-99m MIBI) scintigraphy, ultrasonography, and intraoperative indocyanine green (ICG)-enhanced fluorescence contribute to localization of parathyroid gland 4 and guidance for parathyroidectomy accurately. It assists in limited dissection, cosmetic achievement, and durable cure during transoral endoscopic vestibular approach for focused parathyroidectomy.
Materials and Methods:
The preparation and settings are the same as transoral endoscopic vestibular approach, which has been described before by Anuwong et al.5,6 In the present patient, we obtained limited subplatysma muscle flap dissection followed by smaller working space creation for facilitating left inferior lateral approach to expose the target area of interest instead of splitting the strap muscles at midline and devascularizing or retracting the thyroid lobe based on preoperative Technetium-99m sestamibi (99mTc MIBI) scintigraphy and ultrasonic localization. ICG (Diagnogreen Injection, 2.5 mg/mL) was given in a fixed dose parenterally. 7 Intraoperative ICG-enhanced endoscopic fluorescence imaging systems 1588 AIM (Stryker, Kalamazoo, MI) helped in localizing and confirming the left lower parathyroid lesion during parathyroidectomy. Another endoscopic fluorescence platform PINPOINT (Novadaq, Mississauga, ON, Canada) utilized in PHPT patients brought equal efficacy.
Results and Conclusions:
This video illustrates combined preoperative 99mTc MIBI scintigraphy and ultrasonography with intraoperative ICG-enhanced fluorescence conducting in guidance for focused transoral endoscopic parathyroidectomy vestibular approach. It optimizes distinct horizon of the parathyroid, fulfills excellent cosmetic outcomes, and obtains limited dissection.
Runtime of video: 7 mins 46 secs
Keywords
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