title: Limits and drawbacks of video-assisted parathyroidectomy.
abstract: BACKGROUND
  Minimally invasive video-assisted parathyroidectomy (MIVAP) is a novel minimally invasive approach to primary hyperparathyroidism (PHPT). It is a gasless operation characterized by a single central incision and external retraction. This paper describes the drawbacks and limitations of this procedure based on a 5-year experience and 260 operations.
  
  
  METHODS
  Of 364 patients with PHTP, 260 were selected for MIVAP. In most patients a unilateral minimally invasive exploration was performed.
  
  
  RESULTS
  MIVAP was carried out successfully in 239 patients with a mean operating time of 40 (range 20-180) min. Conversion to cervicotomy was required in 21 patients (8.1 per cent). Complications included recurrent nerve palsy in two patients (0.8 per cent), haemorrhage that required reoperation 6 h after parathyroidectomy in one patient (0.4 per cent) and transient hypoparathyroidism in six patients (2.5 per cent). In five patients (2.1 per cent) persistent PHPT developed shortly after surgery.
  
  
  CONCLUSIONS
  After 5 years of experience, MIVAP appears to be feasible, safe and applicable to the majority of patients with PHPT.
authors.affiliation: Department of Surgery, University of Pisa, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Berti
authors.forename: G
authors.initials: G
authors.lastname: Materazzi
authors.forename: A
authors.initials: A
authors.lastname: Picone
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D017060:Patient Satisfaction; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000592:standards*