Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization.
BACKGROUND
Thoracoscopic surgery has replaced conventional sternotomy or thoracotomy for resection of mediastinal parathyroid lesions. We review our experience with this type of surgery with reference to selection of the appropriate approach and the pitfalls of lesion localization before and during surgery.


METHODS
During a 14-year period, we treated 14 patients with hyperparathyroidism, in whom a mediastinal lesion had been localized preoperatively by sestamibi scan. Primary hyperparathyroidism was present in 12 patients (single adenoma in 11, associated with MEN 1 in one) and secondary hyperparathyroidism in 2. Thoracoscopic procedures were performed by the three-port method.


RESULTS
The thoracoscopic procedure was successful in eight patients who were shown preoperatively to have a deep-seated (5 anterior, 3 middle) mediastinal lesions. Intraoperative visual confirmation of parathyroid adenoma was difficult only in a 19-year-old patient with a tumor embedded in the thymus, necessitating partial thymectomy. One of the eight mediastinal lesions resected thoracoscopically was a sestamibi-positive thymoma. Secondary hyperparathyroidism recurred 4 years after thoracoscopic mediastinal parathyroidectomy in one patient, necessitating additional thoracoscopic removal of this supernumerary lesion. However, seven patients with mediastinal parathyroid lesions localized at the aortic arch or upper region were treated successfully via a cervical approach. None of the patients suffered any surgical complications.


CONCLUSIONS
Thoracoscopic surgery is safe and feasible for resection of deep mediastinal parathyroid lesions. Such lesions localized preoperatively at the aortic arch or upper region can be treated via a cervical approach. Preoperative sestamibi scan can sometimes give a false-positive result in cases of concurrent thymoma.
Department of Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. marsy-ii@mtj.biglobe.ne.jp
Masatoshi
M
Iihara
Rumi
R
Suzuki
Akiko
A
Kawamata
Kiyomi
K
Horiuchi
Takahiro
T
Okamoto
D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D002828:Choristoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D057234:Preoperative Period; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013906:Thoracoscopy / Q000379:methods*; D013945:Thymoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013953:Thymus Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi