Minimally Invasive Video-Assisted Parathyroidectomy Versus Open Minimally Invasive Parathyroidectomy for a Solitary Parathyroid Adenoma: A Prospective, Randomized, Blinded Trial

摘要: A variety of minimally invasive parathyroidectomy (MIP) techniques have been currently introduced to surgical management primary hyperparathyroidism (pHPT) caused by a solitary parathyroid adenoma. This study aimed at comparing the video-assisted MIP (MIVAP) and open (OMIP) in prospective, randomized, blinded trial. Among 84 consecutive pHPT patients referred for surgery, 60 individuals with concordant localization adenoma on ultrasound subtraction Tc99m-MIBI scintigraphy were found eligible under general anesthesia randomized two groups (n = 30 each): MIVAP OMIP. An intraoperative intact hormone (iPTH) assay was routinely used both determine cure. Primary end-points success rate achieving cure from hyperparathyroid state hypocalcemia rate. Secondary operating time, scar length, pain intensity assessed visual-analogue scale, analgesia request rate, analgesic consumption, quality life within 7 postoperative days (SF-36), cosmetic satisfaction, duration hospitalization, cost-effectiveness analysis. All cured. In 2 patients, an iPTH revealed need further exploration: one patient, subtotal hyperplasia performed approach, OMIP approach converted unilateral neck exploration final diagnosis double versus characterized similar operative time (44.2 ± 18.9 vs. 49.7 15.9 minutes; P 0.22), transient (3 3 individuals; 1.0), lower 4, 8, 12, 24 hours after surgery (24.9 6.1 32.2 4.6; 26.4 4.5 32.0 4.0; 19.6 4.9 25.4 3.8; 15.5 5.5 20.4 4.7 points, respectively; < 0.001), (63.3% 90%; 0.01), consumption (51.6 46.4 mg 121.6 50.3 ketoprofen; better physical functioning aspect bodily early recovery (88.4 6.9 84.6 90.3 87.5 5.8; 0.02 0.003, respectively), shorter length (17.2 2.2 mm 30.8 4.0 mm; higher satisfaction 1 month (85.4 12.4% 77.4 9.7%; 0.006). Cosmetic increasing there no significant differences 6 months postoperatively. more expensive (US$1,150 63.4 1,015 61.8; 0.001) while mean hospital stay (28 10.1 31.1 9.7 hours; 0.22). Differences serum calcium values during follow-up nonsignificant. Transient laryngeal nerve palsy appeared patient (P 0.31). There other morbidity or mortality. Both offer valuable excellent minimal Routine use is essential approaches avoid failures overlooked multiglandular disease. The advantages include easier recognition recurrent (RLN), following aspects recovery, However, these are achieved costs because endoscopic tool involvement.