Trans-oral Endoscopic Parathyroidectomy through Vestibular approach: Our 2 year experience

Gagandeep Talwar¹, Chintan Patel, MS², Ajay Bhandarwar, MS, FMAS, FIAGES, , FLCS, FBMS, FICS¹, Amol Wagh, MS¹, Eham Arora, MS¹, Shubham Gupta, MS¹. ¹Grant Govt. Medical College & Sir JJ Group of Hospitals, India, ²Kiran Multi-Super Speciality

OBJECTIVE: Natural orifice transluminal endoscopic surgery for neck surgeries has become increasing popular. Thus, an innovative transoral endoscopic parathyroidectomy through vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT). We aim to review our 2 year experience of this approach.

METHOD: Parathyroid adenoma was localised using combined Sestamibi and CT scan. Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars above incisors. The subplatysmal space was created down to the sternal notch, and carbon dioxide was insufflated at pressure 6 mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathromone levels were measured 10 minutes after excision of gland.

Primary end-points were the success rate in achieving the cure from hyperparathyroid state and hypocalcemia rate. Secondary end-points were operating time, scar length, pain intensity assessed by the visual-analogue scale, analgesia request rate, analgesic consumption, quality of life within 7 postoperative days (SF-36), cosmetic satisfaction, duration of postoperative hospitalization, and cost-effectiveness analysis.

RESULT:

One patient experienced a transient recurrent laryngeal nerve palsy which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT at 30 days was 36.38 ± 7.1 pg/mL (range 27.7-46.5).

Postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found.

CONCLUSION:  With highly sensitive localising Sestamibi and CT scans, focussed exploration is the current standard of treatment. Among all minimally invasive surgeries, TOEPVA is a feasible, safe, and almost pain-free surgical option when combined with Intraoperative Parathormone monitoring for patients with hyperparathyroidism, especially those with cosmetic concerns.

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87276

Program Number: P824

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster