Advantages and Disadvantages

It is difficult to assess the advantages offered by minimally invasive parathyroid surgery because of the many different techniques considered minimally invasive. Similarly, "conventional parathyroidectomy" includes both bilateral and unilateral explorations. Furthermore, early sporadic reports of minimally invasive parathyroidectomy included only few cases that had inadequate follow-up and were not prospective studies.

Possible advantages include cosmetic outcome and postoperative distress. There are two prospective papers comparing a minimally invasive to a conventional approach, both based on less than 50 patients, concluding that patients have less discomfort postoperatively after minimally invasive operations using a radio-guided17 or video-assisted approach.19

The advantage of the cosmetic outcome is generally considered obvious because a scar of 1 to 2 cm tends to be better accepted than a 4- to 6-cm scar in the same region. Patients' satisfaction evaluated in a prospective study by means of a visual analog scale score proved to be significantly better in a minimally invasive video-assisted parathyroidectomy versus a conventional procedure.19

The duration of hospitalization cannot constitute a further advantage because parathyroid surgery is now frequently performed on an outpatient basis, even under locoregional anesthesia, whether the patient is undergoing a minimally invasive8 or a conventional parathyroidectomy.20

Endoscopic procedures are generally more expensive and thus a disadvantage. The expenses are due to surgical instrumentation and the technical support needed to set up a new procedure, as well as the longer duration of the procedure.

The additional costs of preoperative imaging studies are also widely accepted by surgeons using the conventional approaches,21 so this is not an issue.

Furthermore, for minimally invasive surgery using a central approach, bilateral exploration is possible, thus making preoperative localization theoretically superfluous.11 Similarly, qPTHa is used in both conventional and endoscopic operations, and its cost has sharply decreased lately, matching that of frozen section. Many surgeons consider it technically demanding, but the surgical equipment required does not differ much from that needed for other laparoscopic procedures.22

Finally, the higher cost due to longer procedure duration occurs at the beginning of the surgeon's experience. The learning curve (Fig. 50-5), however, clearly shows that a reasonable operating time can be reached after the first 30 operations and it rivals that of conventional surgery. A significant disadvantage for the endoscopic procedures is the need for general anesthesia, whereas in conventional surgery locoregional anesthesia might be used.18 This issue is less relevant in Europe, where the problem of surgery on an outpatient basis is not considered of paramount importance. In our center, patients undergoing video-assisted parathyroidectomy are discharged within 24 hours (overnight stay).

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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