Abstract
INTRODUCTION: Minimally invasive parathyroidectomy is an effective treatment of hyperparathyroidism caused by mediastinal parathyroid tissue. We present a case where we used the mediastinoscope to excise the mediastinal parathyroid gland.
MATERIAL & METHOD: A patient of 82 years was admitted to our department due to hyperparathyroidism and heavy COPD. A thorough examination was conducted including a cervical and chest CT scan followed by a sestamibi scan and selective venous sampling of parathyroid hormone levels. The mediastinal location was carefully determined, but the patient suffered from severe COPD making impossible for the anaesthesiologists to intubate him with a double lumen tube, necessary for the thoracoscopic approach. So, we decided to procede by using the mediastinoscope through a cervical incision sub-sternally. The procedure was successful and the patient was dismissed the next postoperative day. The cure rate was 100% and no complication such as hypocalcemia was observed.
CONCLUSION: Minimally invasive parathyroidectomy by using the mediastinoscope through a cervical incision is an effective treatment of hyperparathyroidism caused by mediastinal parathyroid tissue. Targeted exploration depends on the guidance of preoperative localization studies and measurement of intraoperative parathyroid hormone levels to verify successful resection. Selective venous sampling and high-resolution computed tomography scanning can be helpful in patients with negative sestamibi scans.
- Copyright ©the authors 2016
