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Video-assisted right parathyroidectomy for parathyroid adenoma

This video demonstrates a routine video-assisted parathyroidectomy. The surgeon uses a 1.5 cm midline neck incision to identify the key structures including the carotid artery, the recurrent laryngeal nerve and the parathyroid adenoma. The middle thyroid vessels are divided and the parathyroid adenoma is mobilized, and the vessels are clipped and divided to remove the adenoma. An intraoperative blood assay confirms that the adenoma has been adequately removed.

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Video-assisted   right   parathyroidectomy   for   parathyroid   adenoma

作者群
P Miccoli
摘要
This video demonstrates a routine video-assisted parathyroidectomy. The surgeon uses a 1.5 cm midline neck incision to identify the key structures including the carotid artery, the recurrent laryngeal nerve and the parathyroid adenoma. The middle thyroid vessels are divided and the parathyroid adenoma is mobilized, and the vessels are clipped and divided to remove the adenoma. An intraoperative blood assay confirms that the adenoma has been adequately removed.
分類
routine cases
關鍵字
parathyroidectomy,operation,resection,parathyroid glands,endocrinology
媒體類型
期間
10'00''
刊物
2004-09
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, Sept 2004;4(09).
URL: http://www.websurg.com/doi-vd01en1173e.htm

Video-assisted   right   parathyroidectomy   for   parathyroid   adenoma

1. Case presentation 00'18''
The adenoma is supposed to be an inferior one on the right side, so the incision will be performed just a bit lower than usually only 1cm above the sternal notch. We make an incision of 1.5cm above the sternal notch. The electrocautery is isolated with a thin film. We get inside the subcutaneous tissue, we then use Army-Navy retractors whose size has been prepared purposefully for this minimally invasive surgery. We go along the midline, it is very important to remain on the midline. As there is no gas insufflation, we need a completely bloodless plane. This is like a standard preparation for any laparoscopic surgery, preparing the access and then going inside with the endoscope. The carotid artery is now dissected carefully and it will be retracted laterally. The thyroid lobe is loaded in the lower field here. The carotid artery is prepared and then loaded with a retractor. The parathyroid adenoma is probably already visible; good anatomical landmarks are usually the inferior parathyroid vessels, the middle thyroid vein. We are now exploring the space just to check that the localization is correct and this could be the parathyroid adenoma. The inferior thyroid artery is well evident, the nerve is well prepared. So we have important landmarks for parathyroid glands, we are not sure yet that this is an adenoma, we have to check the size because ultrasonographically it is supposed to be 1.2cm. We put a clip on the middle thyroid vein, then I introduce the scissors, cut the vein, dissect a little bit with the blunt dissection of the scissors. As in the thyroid surgery case, we now change the retractor, we put a retractor with one of the arms deeper that is able to go deeper while retracting the carotid artery. It is important to prepare carefully all the thyroid space to expose the groove between the thyroid, and the esophagus and the trachea because it is exactly where the thyroid adenoma is supposed to be. Now the space is very well prepared. We are just waiting for the blood sample to make the dose regimen of the first PTH, parathyroid hormone. It is important now not to go too far ahead in the manipulation of the gland because this could lead to faults, this is the parathyroid adenoma and we are quite convinced that it could be so because it has changed color a little. It is quite in close contact with the nerve but well separated from it. We are trying to focus on the cleavage plane between what is supposed to be the parathyroid adenoma and the thyroid. We go slowly ahead because as you can see, we are now looking for the hilus of the adenoma. You can see now the vessels that lead to the parathyroid adenoma because only once you have well prepared them, you can put the clip on. Now I think we can try to put a clip; the clip is not well applied; as you can see, it’s not exactly on the hilus, so we must prepare it better. This should be the good point to apply the clip, this is the artery, this is the main vessel of the adenoma. We also have the veins of the hilus. I put only one clip, cutting completely the vessels, now I have to end up with the dissection of the glands. There is probably another small vessel. We grab the pedicle, of course not the capsule of the parathyroid. We check once again the nerve because we must be careful when cutting and applying clips on these vessels. We must leave 5 minutes, then 10 minutes after the resection to measure. No doubt it is a parathyroid adenoma. Now we cut in the middle, this is the typical aspect of the parathyroid parenchyma. All we have to do now is of course check the hemostasis, and above all wait for the PTH assay. I have got the results, the value dropped from 84 to 26, which is of course one third of the value. The operation is over, as you have seen it is short and I hope reliable.