Video-assisted right superior parathyroidectomy

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Video-assisted right superior parathyroidectomy

Authors

Keywords

parathyroidectomy,hyperparathyroidism,minimally invasive,video-assisted surgery

Media type

Surgical video

Duration

03'00''

Publication

2005-05

Popular

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Audio

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E-publication

WeBSurg.com, May 2005;5(05).
URL: http://www.websurg.com/doi-vd01en1796c.htm

Video-assisted right superior parathyroidectomy

1. Skin access 00'18''

Now the thyroid operation is supposed superior right adenoma on preoperative imaging. The central skin incision is 1.5cm in length. We open the linea alba in a bloodless plane. We perform a blunt dissection of the strap muscles and we put the retractors, one in the right lobe and the other one on the strap muscles. We don’t use gas as usual. There you can see the right thyroid lobe, the strap muscles, the right thyroid artery.

2. Carotid artery 01'13''

We use a 5mm, 30 degree endoscope and we can rotate the 30 degrees upside down to better visualize the upper parathyroid adenomas. The aspirator spatula creates the space. Now we are underneath the upper pedicle of the right thyroid lobe. Now the adenoma is in sight close to the esophagus and very posterior with some adhesions around it, especially with the esophagus. We can dissect these adhesions with 2 spatulas. Underneath the adenoma, you can see the vertebral plane. We are very posterior now. We search for and visualize the recurrent nerve to avoid any injury of the nerve.

3. Recurrent nerve 02'37''

Which you can see here along with the inferior thyroid artery. And now we are ready to search for the pedicle of the adenoma. We continue to dissect the adhesions with the esophagus. The pedicle of the adenoma is in sight. We can place a clip on this vessel and then cut. It’s important not to damage the capsule of the adenoma. We place another clip on another vessel close to the adenoma towards its inferior part.

4. Vascular pedicle of adenoma 03'48''

All the instruments are reusable. And now the adenoma can be extracted and we can measure the PTH levels after 5 minutes.

5. End of procedure 04'08''

The operation is over.