Minimally Invasive Parathyroid Surgery

Paolo Miccoli, MD ■ Piero Berti, MD

Minimally invasive procedures proposed for the treatment of primary hyperparathyroidism (PHPT) have become widespread after the first operation performed by Michel Gagner in 1996.1 This term, however, can be misleading if one assumes that the simple shortening of the surgical scar is enough to define a surgical procedure as minimally invasive. In fact, if one uses the guidelines of the 1990 National Institutes of Health Consensus Conference as the starting point, all operations other than bilateral exploration with possible biopsy of suspected enlarged parathyroid glands constitute less invasive surgery; however, less invasive does not mean minimally invasive.

The concept of invasiveness cannot be limited only to the length of the skin incision but must be extended to other structures, and above all this reduction in invasiveness must not decrease the operative field of vision. For this reason, an endoscope is usually (although not always) used in minimally invasive procedures. This chapter examines mainly endoscopic procedures. These can be performed either with gas flow insufflation and trocars or with external retraction instead of gas insufflation.

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