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Berti P, Miccoli P. Video-assisted parathyroidectomy. Epublication: WeBSurg.com, Sept 2004;4(9). URL: http://www.websurg.com/ref/doi-vd01en1176e.htm
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Chirurgie endocrinienne > Glandes parathyroïdes > Hyperparathyroïdie

P Berti (Italy), P Miccoli (Italy)

September 2004
English - 06'00''

Keywords: parathyroidectomy,operation,endocrinology,video assisted,parathyroid glands,resection

 
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00'40'' Case presentation
The operation starts with a 1.5cm skin incision, 2cm above the sternal notch. The skin tissue is dissected to reach the plane of the strap muscles, looking for the midline. This is not an ideal case for video-assisted parathyroidectomy because the patient has got a short and fat neck and the lesion is not very well localized. We have found the midline and we open it as much as possible over a length to 2 to 4cm. We are on the side in which the adenoma is supposed to be and we start dissecting the thyroid lobe from the strap muscles in order to see the carotid artery, which is one of the most important landmarks of this step. This man also has got thyroid nodules, he has a small multinodular goitre. This is the middle thyroid vein. The dissection is done with small instruments such as spatulas or an aspirator with a spatula shape that allows dissection and aspiration at the same time. The parathyroid adenoma was described as a 1.5cm lesion lying very posterior, so we are trying to reach the posterior plane.
Now we cut the branch of the inferior thyroid artery.
After having cut some small vessels, we are going towards the upper pedicle on the posterior plane, looking for the upper right parathyroid. You see now the esophagus is almost completely freed on the upper part of the operative space and we go down. This is the posterior plane, the bone plane, no adenoma is present in this space.
This should be the pedicle of the adenoma; there are small lymphatic vessels on the left and we can cut them without any clips, they will not bleed.
This is a 1.5cm long and 1cm large parathyroid adenoma. The color is suggestive. We do the final check of the operative field.

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