Endoscopic Surgery via Thoracic-Breast Approach in the Treatment of Thyroid Cancer Combined with Parathyroid Tumor

Abstract

Introduction:

The coexistence of thyroid cancer and parathyroid tumor, although rare, presents unique challenges in diagnosis and management. Traditional open surgery has been the cornerstone of treatment for these conditions; however, with the advancement of minimally invasive surgical techniques, endoscopic surgery has emerged as a promising alternative. The primary advantage of endoscopic thyroid surgery over open surgery lies in its superior cosmetic outcome. This case report details the successful application of this technique in the management of a patient with concurrent thyroid cancer in the left lobe and a right-sided superior parathyroid tumor.

Materials and Methods:

This video presentation describes the successful application of the thoracic-breast approach in the concurrent management of left-lobe thyroid cancer and a right-sided superior parathyroid tumor. A 35-year-old female patient presented with a thyroid carcinoma and a parathyroid tumor during a routine follow-up examination. The urinary system ultrasonography indicates multiple renal stones in both kidneys, and the bone mineral density test suggests osteoporosis in the thoracic and lumbar vertebrae. Ultrasonography also revealed an 11 × 9 mm solid nodule in the left lobe of the thyroid, and fine-needle aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. In addition, ultrasonography and choline PET-CT revealed a 20 × 12 mm parathyroid adenoma situated at the upper pole of the right thyroid lobe, adjacent to the bifurcation of the common carotid artery on the lateral aspect. Given the patient’s desire for a good cosmetic outcome, endoscopic surgery via the thoracic-breast approach was recommended.

Results:

The video illustrates the surgical procedure for treating left-lobe thyroid cancer and a right-sided superior parathyroid tumor through the endoscopic thoracic-breast approach. The patient recovered uneventfully, and the scar was well-hidden, preserving a good cosmetic outcome. Histopathological examination of the resected specimen confirmed the diagnosis of papillary thyroid carcinoma and parathyroid adenoma. The patient remains disease-free at her latest follow-up visit.

Conclusions:

The endoscopic technique via the thoracic-breast approach provides distinct advantages in thyroid and parathyroid surgeries, fulfilling aesthetic expectations while bolstering surgical safety and precision. For the patient in this case with concurrent thyroid carcinoma of the left lobe and a high-positioned parathyroid tumor on the right side, the incision design of open surgery frequently falls short, potentially requiring the extension of the incision or a second incision, thus escalating the complexity and risk of the procedure. The current case highlights the exceptional capability of the thoracic-breast approach in managing bilateral lesions and high-positioned neck tumors simultaneously, all while preserving neck aesthetics. As a result, this technique has ushered in a safer, more precise, and aesthetically appealing new approach for thyroid and parathyroid surgeries.

The authors have no conflicts of interest to disclose. Consent for video recording and publication was obtained from the patient.

Runtime of video: 6 mins 11 secs