title: Feasibility of video-assisted bilateral neck exploration for patients with primary hyperparathyroidism and failed or discordant localization studies.
abstract: OBJECTIVE
  Minimally invasive video-assisted parathyroidectomy (MIVAP) is generally adopted for patients affected by primary hyperparathyroidism (pHPT) with clear preoperative localization. Standard bilateral neck exploration (BNE) is considered the obligate surgery for patients with unlocalized glands. We reviewed our experience of minimally invasive video-assisted BNE in patients with pHPT and negative or discordant localization studies.
  
  
  METHODS
  From a prospective series of 576 MIVAP for pHPT, 107 patients (19 males, 88 females; mean age 58 years) with failed localization studies underwent BNE using the video-assisted technique. Operative time, complications, conversions to standard cervical exploration, and cure rate were analyzed.
  
  
  RESULTS
  MIVAP with BNE was successfully completed in 99 (93 %) patients with 8 conversions. Mean operative time was 57 ± 37 min (range 20-180 min). Permanent recurrent laryngeal nerve palsy occurred in one patient. Biochemical cure was achieved in 104 patients (97 %). Five patients required a reoperation in the immediate postoperative period, which achieved cure in four. Two patients remained with persistent disease; one developed recurrence disease 3 years after the first exploration.
  
  
  CONCLUSIONS
  In experienced hands, video-assisted BNE for pHPT is feasible and safe and provides results equivalent to the conventional open technique.
authors.affiliation: Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136 Essen, Germany. pieroalesina@libero.it
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Alesina
authors.forename: Jakob
authors.initials: J
authors.lastname: Hinrichs
authors.forename: Matthias
authors.initials: M
authors.lastname: Heuer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hofmeister
authors.forename: Beate
authors.initials: B
authors.lastname: Meier
authors.forename: Martin K
authors.initials: MK
authors.lastname: Walz
mesh_terms: D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009333:Neck / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011877:Radionuclide Imaging; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography; D020535:Video-Assisted Surgery / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology
chemical_list: D017256:Technetium Tc 99m Sestamibi