title: Endoscopic parathyroidectomy: report of an initial experience.
abstract: BACKGROUND
  Preoperative localization of parathyroid lesions and intraoperative quick parathyroid hormone (PTH) assay have been proposed to minimize the extent of operation in primary hyperparathyroidism. To this purpose, endoscopic procedures have been introduced recently.
  
  
  METHODS
  During a period of 13 months, 39 of 65 consecutive patients with primary hyperparathyroidism were selected for endoscopic parathyroidectomy on the basis of the following criteria: preoperative echographic diagnosis of a single adenoma, absence of nodular goiter, and no prior neck operations. Unilateral neck exploration and excision of the adenoma was performed through a gasless procedure combined with intraoperative PTH measurements. Mean follow-up after the operation was 7 months (range 1 to 13 months).
  
  
  RESULTS
  Thirty-nine parathyroid adenomas were removed; the mean diameter was 21 mm (range 5 to 30 mm). The mean operative time was 65 minutes (range 30 to 180 minutes). In all cases PTH concentration decreased significantly. Patients who underwent endoscopic parathyroidectomy had less postoperative pain compared with patients who underwent conventional hemithyroidectomy. At follow-up, serum calcium and PTH levels were normal in all cases.
  
  
  CONCLUSIONS
  Endoscopic parathyroidectomy proved to be a feasible surgical procedure that can be performed in an acceptable operative time with an excellent cosmetic result. The gasless approach avoided any emphysema.
authors.affiliation: Department of Surgery, University of Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
authors.forename: C
authors.initials: C
authors.lastname: Bendinelli
authors.forename: E
authors.initials: E
authors.lastname: Vignali
authors.forename: S
authors.initials: S
authors.lastname: Mazzeo
authors.forename: G M
authors.initials: GM
authors.lastname: Cecchini
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: C
authors.initials: C
authors.lastname: Marcocci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*