title: A retrospective case-controlled study of video-assisted versus open minimally invasive parathyroidectomy.
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) with intraoperative parathyroid hormone assay (IOPTH) has successfully replaced conventional neck exploration in most patients with primary hyperparathyroidism (pHPT) and preoperatively localized parathyroid adenoma.
  
  
  OBJECTIVE
  To compare outcomes of video-assisted MIP (MIVAP) to open MIP (OMIP).
  
  
  METHODS
  A retrospective case-controlled study of 455 patients with sporadic pHPT undergoing MIP with IOPTH at our institution in 2003-2012 was undertaken. The primary outcome measure was postoperative pain. Secondary outcome measures were: duration of surgery, recurrent laryngeal nerve (RLN) identification rate, conversion rate, length of hospital stay, cure rate, patients' satisfaction with cosmetic outcome, morbidity, costs, and diagnostic accuracy of IOPTH.
  
  
  RESULTS
  Of 455 patients with pHPT and a solitary parathyroid adenoma on preoperative imaging, 151 underwent MIVAP and 304 had OMIP. The following outcomes were favourable for MIVAP vs. OMIP: lower pain intensity during 24 h postoperatively (p < 0.001), lower analgesia request rate (p < 0.001), lower analgesics consumption (p < 0.001), higher recurrent laryngeal nerve identification rate (p < 0.001), shorter scar length (p < 0.001), and better cosmetic satisfaction at 1 month (p = 0.013) and at 6 months (p = 0.024) after surgery. However, MIVAP vs. OMIP had longer duration of surgery (p < 0.001), and was more expensive (p < 0.001). No differences were noted in the conversion rate, length of hospital stay, and morbidity.
  
  
  CONCLUSIONS
  Both MIVAP and OMIP approaches were equally safe and effective. However, the outcomes of MIVAP operations were superior to OMIP in terms of lesser postoperative pain, lower analgesics consumption, and better cosmetic satisfaction resulting from a smaller scar.
authors.affiliation: Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczyński
authors.affiliation: Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Papier
authors.affiliation: Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.affiliation: Department of General, Vascular, and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Nawrot
keywords: intraoperative parathyroid hormone assay; minimally invasive parathyroidectomy; minimally invasive video-assisted parathyroidectomy; open minimally invasive parathyroidectomy