title: Less is more: time to expand the indications for minimally invasive video-assisted parathyroidectomy.
abstract: OBJECTIVE
  Minimally invasive video-assisted parathyroidectomy (MIVAP) is one of the most widespread targeted parathyroid surgeries for primary hyperparathyroidism (PHP). The aim of this study was to assess its limits and propose an expansion of its indications in the management of parathyroid pathology.
  
  
  METHODS
  A retrospective analysis of 77 consecutive patients who underwent MIVAP for PHP between Jan and Oct 2016 was conducted. The adequacy of the procedure and/or the need to convert to a standard cervicotomy was the main outcome of interest. Secondary outcomes of interest included: operative time, postoperative morbidity, postoperative pain assessed by the visual analogue scale (VAS) score, and the length of the surgical incision.
  
  
  RESULTS
  There were 64 females and 13 males with a mean age of 51 years. In one patient a concomitant en bloc thyroid lobectomy was required due to features suspicious of parathyroid carcinoma while exploration was required in two other patients. None of these three cases required conversion to standard cervicotomy. The mean operative time, length of incision and VAS score was 31 min, 17 mm and 1.6, respectively. Biochemical cure was achieved in all patients, and no postoperative morbidities were reported.
  
  
  CONCLUSIONS
  MIVAP offers the ability to perform a neck exploration and/or an en bloc thyroid lobectomy without the need to convert to a standard cervicotomy. Therefore, it not only serves as a targeted parathyroid procedure but also a potential alternative to full neck exploration.
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. sohail.bakkar@gmail.com.|Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan. sohail.bakkar@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Bakkar
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Matteucci
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Corsini
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pagliaro
authors.affiliation: Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000592:standards*; D061646:Operative Time; D016105:Parathyroidectomy / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors; D020535:Video-Assisted Surgery / Q000379:methods / Q000592:standards*
keywords: Endoscopic parathyroidectomy; Focused parathyroidectomy; Minimally invasive parathyroid surgery