Therapy of suspected intrathoracic parathyroid adenomas. Experiences using open transthoracic approach and video-assisted thoracoscopic surgery.
OBJECTIVE
Ectopic mediastinal parathyroid adenoma as a cause of primary hyperparathyroidism (pHPT) can normally be resected from conventional collar incision. In rare cases with adenomas deeper in the chest, a transthoracic approach is necessary.


METHODS
We report our experience of 19 patients with suspected mediastinal parathyroid adenomas from a total of 1035 patients with pHPT who were operated on between 1986 and 2000 using an open approach (sternotomy or thoracotomy) or video-assisted mediastinal or thoracoscopic surgery (VAMS/VATS).


RESULTS
Fourteen patients underwent an open approach with a success rate of 71% (10 of 14). Four patients remained hypercalcaemic. There were four complications in three patients: three permanent recurrent nerve palsies and one chylus fistula, requiring further surgery. VATS was successful in three of four patients with conversion to sternal splitting because of a false-negative frozen section in one patient. Another patient had parathyroid adenoma retrosternally which could not be resected by means of VAMS and had to be excised using a transsternal approach. There were no complications of minimal invasive procedures. All five patients were normocalcaemic after the operation.


CONCLUSIONS
Ectopic parathyroid adenomas not resectable by means of a collar incision are rare causes of pHPT and comprise 1.25% of all patients with pHPT in our series. For these patients, VATS revealed an alternative to conventional open procedures. In questionable cases, however, the collar incision should precede the VATS procedure.
Cupisti
Kenko
K
Klinik für Allgemein- und Unfallchirurgie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. cupisti@uni-duesseldorf.de
Dotzenrath
Cornelia
C
Simon
Dietmar
D
Röher
Hans-Dietrich
HD
Goretzki
Peter E
PE
D000236:Adenoma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008481:Mediastinoscopy; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome