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Video-assisted right upper parathyroidectomy for hyperparathyroidism

Video-assisted parathyroidectomy is also known as minimally invasive video-assisted parathyroidectomy and endoscopic parathyroidectomy. Several techniques of video-assisted parathyroidectomy have been described using approaches from the middle of the neck or the side of the neck. This video shows a video-assisted right upper parathyroidectomy for hyperparathyroidism with 3D reconstruction.

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Video-assisted right upper parathyroidectomy for hyperparathyroidism

作者群

M Vix, L Soler, J Marescaux

摘要

Video-assisted parathyroidectomy is also known as minimally invasive video-assisted parathyroidectomy and endoscopic parathyroidectomy. Several techniques of video-assisted parathyroidectomy have been described using approaches from the middle of the neck or the side of the neck. This video shows a video-assisted right upper parathyroidectomy for hyperparathyroidism with 3D reconstruction.

媒體類型

手術影片

期間

04'58''

刊物

2011-11

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Nov 2011;11(11).
URL: http://www.websurg.com/doi-vd01en3468.htm

Video-assisted right upper parathyroidectomy for hyperparathyroidism

1. Introduction 00'18''

For all our cases of primary hyperparathyroidism, we perform a CT-scan of the neck with contrast injection. The CT-scan helps to reconstruct the cervical area in three dimensions showing the different organs. Thanks to the 3D reconstruction software, any anatomical structure may be removed in order to keep only the relevant anatomy, and especially the axis of the vascular network, the axis of the airways, the thyroid, and the parathyroid glands. In the present case, using a frontal view, a parathyroid gland situated in a lateral esophageal position may be identified. Using a posterior view, the manipulation of this virtual image helps to check that this image is in the area of migration of an upper parathyroid gland. It is easily identified here. The image can then be placed in an operative position in order to prepare the reflection of the minimally invasive approach to this parathyroid adenoma.

2. Incision 01'24''

A 2.5cm incision made 2cm above the sternal notch is performed. The lateral recess of the neck is slowly entered. Two specific Miccoli-type retractors are used to retract both the thyroid gland and the muscles. The first objective is to identify the inferior thyroid artery and the recurrent nerve. The lateral approach to the neck helps to very rapidly identify these structures.

3. Inferior thyroid artery and recurrent nerve identification 02'06''

The inferior thyroid artery is visualized extremely easily. Anterior to this inferior thyroid artery, the recurrent nerve is also rapidly found. A monopolar hook may be used to carry out the cervical dissection. As soon as the noble structures are identified, attention can then be turned rapidly to the area where the parathyroid adenoma has been identified.

4. Thyroid gland retraction and dissection 02'43''

The thyroid gland is retracted. Dissection is then turned above and posterior to the inferior thyroid artery in order to rapidly enter the lateral esophageal recess.

5. Adenoma identification 02'57''

Very rapidly, one can find an upper parathyroid adenoma. It has been identified thanks to its vascular supply, which originates in the most cranial branch of the inferior thyroid artery and then migrates posteriorly to the artery.

6. Adenoma dissection 03'19''

At this time in the procedure, it is critical to dissect the adenoma and its vascular supply completely, making sure that there is no persistent adenomatous parathyroid tissue that would incur a risk of rapid recurrence. Dissection of the pedicle is carried out slowly in order to identify all these structures. Particular attention is paid to the capsule of the parathyroid gland, which is not opened. The hook allows to resect the perivascular adipose tissue. A clip is then applied to achieve hemostasis.

7. Adenoma pedicle division 04'13''

Division of the pedicle is hence completed and the parathyroid adenoma is therefore totally freed. Our attention is then turned anterior to the artery nerve intersection in order to find again the lower parathyroid gland. In this case, a Zuckerkandl’s nodule makes this dissection uneasy, with a risk of parathyroid devascularization. It will not be searched for by stopping the intervention at this moment and by controlling the evolution of rapid PTH assays.