Videothoracoscopic excision of mediastinal parathyroid adenoma in primary hyperparathyroidism
Authors:
P. Libánský 1; P. Broulík 2; M. Fialová 1; J. Kubinyi 3; R. Lischke 1
; D. Táborská 4; J. Tvrdoň 1; J. Šedý 5; S. Adámek 1
Authors place of work:
III. chirurgická klinika 1. LF Univerzity Karlovy a FN Motol, Praha
přednosta: prof. MUDr. R. Lischke, PhD.
1; III. Interní klinika 1. LF Univerzity Karlovy a VFN, Praha
přednosta: prof. MUDr. Š. Svačina, DrSc., MBA
2; Ústav nukleární medicíny 1. LF Univerzity Karlovy a VFN, Praha
přednosta: prof. MUDr. M. Šámal, DrSc.
3; Klinika nukleární medicíny a endokrinologie 2. LF Univerzity Karlovy a FN Motol, Praha
přednosta: prof. MUDr. P. Vlček, CSc.
4; Ústav normální anatomie, LF Univerzity Palackého v Olomouci
přednosta ústavu: doc. RNDr. P. Mlejnek, Ph. D.
5
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 6, s. 245-248.
Category:
Case Report
Summary
Introduction:
Primary hyperparathyroidism is a disease caused by elevated secretion of parathyroid hormone from pathological parathyroid glands. After the diagnosis, the success of its surgical solution depends predominantly on surgical management and experience of the surgeons. A special group is formed by ectopic localizations of pathologically enlarged parathyroid glands in the mediastinum, which require a modified surgical approach. When the adenoma is deep in the mediastinum, sternotomy or thoracotomy is indicated; alternatively, a minimally invasive approach can be used – videothoracoscopic thymectomy.
Case report:
We present a case of a patient with normocalcemic recurrent primary hyperparathyroidism. This patient underwent a minimally invasive video-assisted thymectomy after scintigraphic confirmation of parathyroid adenoma in the mediastinum.
Conclusion:
The removal of parathyroid adenoma in the mediastinum using the videothoracoscopic method is safe. Compared to sternotomy, this method improves the postoperative period, reduces the length of stay and provides more comfort to patients. We recommend considering the videothoracoscopic method in cases where the pathologically enlarged parathyroid gland is localized in the inferior and anterior mediastinum.
Key words:
primary hyperparathyroidism −adenoma of glandula parathyroidea – mediastinum − miniinvasive
Zdroje
1. Iacobone M, Mondi I, Viel G, et al. The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients. Langenbecks Arch Surg 2010;395:947−53.
2. Cupisti K, Dotzenrath C, Simon D, et al. Therapy of suspected intrathoracic parathyroid adenomas. Experiences using open transthoracic approach and video-assisted thoracoscopic surgery. Langenbecks Arch Surg 2002;386:488–93.
3. Adámek S, Naňka O. Embryologie, mikroskopická a klinická anatomie příštítných žláz. In: Primární hyperparathyreóza. Praha, Galén 2006:19−20.
4. Nathaniels EK, Nathaniels AM, Wang CA. Mediastinal parathyroid tumors: a clinical and pathological study of 84 cases. Ann Surg 1970;171:165−70.
5. Nwariaku FE, Snyder WH, Burkey SH, et al. Inframanubrial parathyroid glands in patients with primary hyperparathyroidism: alternatives to sternotomy. World J Surg 2005;29:491–4.
6. Wei JP, Gadacz TR, Weisner LF, et al. The subxiphoid laparoscopic approach for resection of mediastinal parathyroid adenoma after successful localization with TC-99m-sestamibi radionuclide scan. Surg Laparosc Endosc 1995;5:402–6.
7. Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg 1999;67:263−5.
8. Callender GG, Grubbs EG, Vu T, et al. The fallen one: the inferior parathyroid gland that descends into the mediastinum. J Am Coll Surg 2009;208:887–93.
9. Alesina PF, Moka D, Mahlstedt J, et al. Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg 2008;32:224–31.
10. Randone B, Costi R, Scatton O, et al. Thoracoscopic removal of mediastina parathyroid glands: a critical appraisal of an emerging technique. Ann Surg 2009;251:717–1.
11. Russell CF, Edis AJ, Scholz DA, et al. Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg 1981;193:805–9.
12. Ravipati NB, McLemore EC, Schlinkert RT, et al. Anterior mediastinotomy for parathyroidectomy. Am J Surg 2008;195:799–802.
13. Moreno P, Francos JM, Shaha A, et al. Intercostal video-assisted mediastinal surgery through an intercostal window (IVAMS): a simpler approach to perform mediastinal parathyroidectomy. Surgery 2007;142:410–13.
14. Tcherveniakov P, Menon A, Milton R, et al. Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma. J Cardiothorac Surg 2007;2:41.
15. Bodner J, Wykypiel H, Greiner A, et al. Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg 2004;78:259–65.
16. Ismail M, Maza S, Swierzy M, et al. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg 2010;97:337−43.
17. Sukumar MS, Komanapalli CB, Cohen JI. Minimally invasive management of the mediastinal parathyroid adenoma. Laryngoscope 2006;116:482–7.
18. Doherty GM, Doppman JL, Miller DL, et al. Results of multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Ann Surg 1992;215:101–6.
19. Pafko P, Schützner J. Initial experience with videothoracoscopy. Rozhl Chir 1993;72:279−80.
20. Nilubol N, Beyer T, Prinz RA, et al. Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome. Am J Surg 2007;194:53−6.
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