Thoracoscopic Removal of Mediastinal Parathyroid Lesions: Selection of Surgical Approach and Pitfalls of Preoperative and Intraoperative Localization
| Autor: | Rumi Suzuki, Kiyomi Horiuchi, Takahiro Okamoto, Masatoshi Iihara, Akiko Kawamata |
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| Rok vydání: | 2011 |
| Předmět: |
Adenoma
Adult Male Technetium Tc 99m Sestamibi medicine.medical_specialty Thymoma medicine.medical_treatment Choristoma Parathyroid Glands Lesion Intraoperative Period Mediastinal Diseases medicine Humans Thoracotomy Aged Retrospective Studies Parathyroidectomy Tomography Emission-Computed Single-Photon Hyperparathyroidism business.industry Thoracoscopy Thymus Neoplasms Middle Aged Vascular surgery Hyperparathyroidism Primary medicine.disease Surgery Cardiac surgery Parathyroid Neoplasms Treatment Outcome Cardiothoracic surgery Preoperative Period Female Hyperparathyroidism Secondary Radiology Radiopharmaceuticals medicine.symptom business Follow-Up Studies Abdominal surgery |
| Zdroj: | World Journal of Surgery. 36:1327-1334 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/s00268-011-1404-0 |
| Popis: | Thoracoscopic surgery has replaced conventional sternotomy or thoracotomy for resection of mediastinal parathyroid lesions. We review our experience with this type of surgery with reference to selection of the appropriate approach and the pitfalls of lesion localization before and during surgery.During a 14-year period, we treated 14 patients with hyperparathyroidism, in whom a mediastinal lesion had been localized preoperatively by sestamibi scan. Primary hyperparathyroidism was present in 12 patients (single adenoma in 11, associated with MEN 1 in one) and secondary hyperparathyroidism in 2. Thoracoscopic procedures were performed by the three-port method.The thoracoscopic procedure was successful in eight patients who were shown preoperatively to have a deep-seated (5 anterior, 3 middle) mediastinal lesions. Intraoperative visual confirmation of parathyroid adenoma was difficult only in a 19-year-old patient with a tumor embedded in the thymus, necessitating partial thymectomy. One of the eight mediastinal lesions resected thoracoscopically was a sestamibi-positive thymoma. Secondary hyperparathyroidism recurred 4 years after thoracoscopic mediastinal parathyroidectomy in one patient, necessitating additional thoracoscopic removal of this supernumerary lesion. However, seven patients with mediastinal parathyroid lesions localized at the aortic arch or upper region were treated successfully via a cervical approach. None of the patients suffered any surgical complications.Thoracoscopic surgery is safe and feasible for resection of deep mediastinal parathyroid lesions. Such lesions localized preoperatively at the aortic arch or upper region can be treated via a cervical approach. Preoperative sestamibi scan can sometimes give a false-positive result in cases of concurrent thymoma. |
| Databáze: | OpenAIRE |
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