title: Video-assisted minimally invasive parathyroidectomy: benefits and long-term results.
abstract: BACKGROUND
  In recent years several endoscopic and video-assisted techniques for parathyroidectomy have been described. The role of these techniques, with respect to time-honored conventional surgery, has been largely debated. This paper was designed to review the evidence, and make the recommendations, for the video-assisted/endoscopic approach to parathyroidectomy.
  
  
  METHODS
  A database search was conducted in PubMed from which abstracts were screened matching our definition. Publications were further assessed and assigned their respective level of evidence. Additional data were obtained on the basis of our personal experience.
  
  
  RESULTS
  Thirty-eight mainly retrospective studies have been published. Only four small, prospective, randomized trials, providing level II evidence, and one retrospective case-control comparative study, providing level IV evidence, have been found. Minimally invasive video-assisted parathyroidectomy (MIVAP) has emerged as one of the leading techniques. To date several randomized studies have shown that MIVAP is an efficacious and feasible procedure with the same complications rate as conventional surgery. Moreover, MIVAP seems to have significant advantages in terms of cosmetic result, postoperative pain and recovery, and patient satisfaction.
  
  
  CONCLUSIONS
  From an evidence-based point of view, MIVAP should be considered a valid and validated option for the treatment of sporadic primary hyperparathyroidism sustained by a well-localized, single adenoma. Its role for the treatment of multiglandular diseases (familial hyperparathyroidism, secondary hyperparathyroidism) needs to be better clarified.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
authors.forename: Celestino P
authors.initials: CP
authors.lastname: Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Traini
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Corsello
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
mesh_terms: D004724:Endoscopy; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods; D020535:Video-Assisted Surgery