Laparoscopic thyroid and parathyroid surgery

A basic prerequisite for the success of minimally invasive parathyroid surgery is an exact preoperative localization diagnosis of the enlarged parathyroid gland (sestamibiscintigraphy, ultrasound, CT or NMR). Furthermore, there should be no large nodular goiter and no previous surgery or radiation should have taken place in the neck area. A suspected malignant disease of the parathyroid or thyroid gland is also a contraindication for the endoscopic surgical technique. The ideal candidate for minimally invasive video-assisted parathyroid or thyroid surgery is therefore a patient with a solitary adenoma of the parathyroid or thyroid gland.

In the endoscopic surgical technique, an approximately 1.5 centimeter long skin incision is made above the jugular fossa. Under video camera assistance, fine instruments are used to bluntly open up the space between the thyroid gland and the vascular nerve sheath and to visit the enlarged parathyroid gland. The vessels are severed between ligatures or metal clips and the epithelial body is retrieved. The vocal cord nerve can be precisely identified due to the optical magnification. A struma node can be removed in a similar way using this minimal surgical approach.

The intraoperative rapid determination of parathyroid hormone levels is a basic prerequisite for the successful performance of the endoscopic operation; if successful, the parathyroid hormone level must drop to normal within ten minutes after removal of the diseased parathyroid gland.

The advantages of the minimally invasive surgical technique are certainly better cosmetic results as well as a lower postoperative pain load and a faster convalescence of the patients. It is estimated that possibly 15 to 20 percent of all parathyroid and thyroid operations can be performed minimally invasively if the above mentioned criteria are observed. However, conventional methods still retain their value for the treatment of those patients in particular, in whom an exact further localization of the parathyroid glands is not possible, in the presence of a multiple gland disease, when a second operation is necessary or in the presence of a large goiter.

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