title: Endoscopic parathyroidectomy: why and when?
abstract: BACKGROUND
  In recent years, several new minimally invasive techniques for parathyroidectomy (MIP) have been developed. There was a rapid worldwide acceptance of mini-open procedures by most surgeons. However, the use of an endoscope remains debatable. This study was designed to determine the role of preoperative imaging studies in the decision-making for using an endoscope during MIP.
  
  
  METHODS
  All patients with sporadic primary hyperparathyroidism (PHPT) and candidate for MIP underwent localizing studies. MIP was proposed only for patients in whom a single adenoma was localized by both ultrasonography and sestamibi scanning. Three locations were described: (1) posterior to the two superior thirds of the thyroid lobe; (2) at the level of or below the inferior pole of the thyroid lobe but in a plane posterior to it; (3) at the level of or below the tip of the inferior pole of the thyroid lobe but in a superficial plane. In locations 1 and 2, the nerve was considered to be at risk and an endoscopic lateral approach was indicated. In location 3, a mini-open approach was indicated.
  
  
  RESULTS
  Of the 165 patients operated on for PHPT in 2006, 86 underwent MIP. According to the results of imaging studies, 39 patients presented an adenoma in location 1, 21 in location 2, and 26 in location 3. In locations 1 and 2, 59 patients (1 false-positive) had an adenoma that was located posteriorly, in close proximity to the nerve; all were cured. In location 3, 25 patients (1 false-positive) presented an inferior parathyroid adenoma superficially located; all were cured. There was no transient or permanent laryngeal nerve palsy.
  
  
  CONCLUSIONS
  In patients who are candidates for MIP, we recommend the use of the endoscope for the resection of parathyroid adenomas that are located deeply in the neck.
authors.affiliation: Department of Endocrine Surgery, University Hospital La Timone, 264 Rue Saint-Pierre, Cedex 05, 13385, Marseilles, France. jfhenry@ap-hm.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Henry
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sebag
authors.forename: Mariya
authors.initials: M
authors.lastname: Cherenko
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.forename: David
authors.initials: D
authors.lastname: Taieb
authors.forename: Josiane
authors.initials: J
authors.lastname: Vaillant