Özer Makay1, Mehmet Zafer Sabuncuoğlu2, Mehmet İlker Turan3, Ismail Cem Sormaz4, Murat Özdemir5, Nurcihan Aygün6, Serhat Buldur7, Yiğit Türk5, Demet Sarıdemir8, Atakan Sezer9, Serkan Teksöz10, Mehmet Uludağ6, İsmail Zihni2, Fatih Tunca4, Mehmet Hacıyanlı11, Cumhur Arıcı8, Yasemin Giles Şenyürek4. 1. Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, Izmir, Turkey. ozer.makay@ege.edu.tr. 2. Division of Endoscopic-Laparoscopic & Minimally Invasive Surgery, Department General Surgery, Suleyman Demirel University Hospital, Isparta, Turkey. 3. Elmali State Hospital, Antalya, Turkey. 4. Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5. Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, Izmir, Turkey. 6. Department of General Surgery, Health Sciences University Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey. 7. Department of General Surgery, Can Hospital, Izmir, Turkey. 8. Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey. 9. Department of General Surgery, School of Medicine, Trakya University, Edirne, Turkey. 10. Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey. 11. Department of General Surgery, Izmir Katip Çelebi University Hospital, Izmir, Turkey.
Abstract
AIM: Parathyroid surgery has witnessed a significant evolution with the introduction of more efficacious preoperative localization imaging techniques and the use of rapid intraoperative parathormone assays. Parathyroid surgery can now be performed with the minimum of invasion. Through the adaptation of the transoral endoscopic thyroidectomy vestibular approach (TOETVA), the technique has now been adopted for parathyroid surgery, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). We present here the initial experiences of 11 centers carrying out TOEPVA surgery in Turkey. MATERIALS AND METHODS: Participating in the study were 11 centers, all of which were tertiary care institutions carrying out endocrine surgery. A retrospective review was made of 35 primary hyperparathyroidism patients who underwent the TOEPVA procedure between July 2017 and January 2020. RESULTS: Of the total 35 patients, 32 patients underwent the TOEPVA procedure successfully. All patients but one were female, and the mean age was 47.2 (20-73) years. According to localization studies, 18 of the lesions were lower left, 12 were lower right, 3 were upper right and 2 were upper left. The mean operative time was 116 (30-225) min, and three cases were converted to an open procedure. Simultaneous thyroidectomy was performed in seven cases. The average PTH level dropped to normal within 20 min. after the resection in all cases. The complication rate was 19% (ecchymosis, subcutaneous emphysema, nasal bleeding, surgical site infection and seroma). There were neither recurrent nerve palsies, nor mental nerve root or branch injuries. The average hospital stay was 1 day. No persistence was documented on follow up. CONCLUSION: TOEPVA is a "hidden scar" parathyroidectomy procedure that can be safely performed on parathyroid adenomas, in cases that have scar-related concerns. Having its own procedure-related complications, the procedure provides satisfactory objective results, particularly in centers experienced in endoscopic and endocrine surgery.
AIM: Parathyroid surgery has witnessed a significant evolution with the introduction of more efficacious preoperative localization imaging techniques and the use of rapid intraoperative parathormone assays. Parathyroid surgery can now be performed with the minimum of invasion. Through the adaptation of the transoral endoscopic thyroidectomy vestibular approach (TOETVA), the technique has now been adopted for parathyroid surgery, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). We present here the initial experiences of 11 centers carrying out TOEPVA surgery in Turkey. MATERIALS AND METHODS: Participating in the study were 11 centers, all of which were tertiary care institutions carrying out endocrine surgery. A retrospective review was made of 35 primary hyperparathyroidism patients who underwent the TOEPVA procedure between July 2017 and January 2020. RESULTS: Of the total 35 patients, 32 patients underwent the TOEPVA procedure successfully. All patients but one were female, and the mean age was 47.2 (20-73) years. According to localization studies, 18 of the lesions were lower left, 12 were lower right, 3 were upper right and 2 were upper left. The mean operative time was 116 (30-225) min, and three cases were converted to an open procedure. Simultaneous thyroidectomy was performed in seven cases. The average PTH level dropped to normal within 20 min. after the resection in all cases. The complication rate was 19% (ecchymosis, subcutaneous emphysema, nasal bleeding, surgical site infection and seroma). There were neither recurrent nerve palsies, nor mental nerve root or branch injuries. The average hospital stay was 1 day. No persistence was documented on follow up. CONCLUSION: TOEPVA is a "hidden scar" parathyroidectomy procedure that can be safely performed on parathyroid adenomas, in cases that have scar-related concerns. Having its own procedure-related complications, the procedure provides satisfactory objective results, particularly in centers experienced in endoscopic and endocrine surgery.
Authors: M R Pelizzo; C Pagetta; A Piotto; N Sorgato; I Merante Boschin; A Toniato; G Grassetto; D Rubello Journal: Minerva Endocrinol Date: 2008-02-22 Impact factor: 2.184
Authors: David Liao; Lisa E Ishii; Lena W Chen; Jonlin Chen; Michelle Juarez; Halley M Darrach; Anisha R Kumar; Jonathon O Russell; Ralph P Tufano; Masaru Ishii Journal: Laryngoscope Date: 2019-10-29 Impact factor: 3.325