Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery.

Abstract

Natural orifice transluminal endoscopic surgery developed for neck surgery become increasing popular. Herein, an innovative transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT) and renal hyperparathyroidism (rHPT). Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars laterally. The subplatysmal space was created down to the sternal notch, and carbon dioxide pressure was insufflated at 6mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathyroid hormone level and frozen section were conducted. Autotransplantation of the parathyroid gland was performed at the non-dominant forearm in an rHPT patient. From March 2015 to June 2016, TOEPVA was successfully performed in 12 patients (six PHPT and six rHPT). The mean operative time for parathyroidectomy in PHPT patients was 107.5min (range 88-127) and 185.8min in rHPT patients (range 155-214). One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT and the rHPT group at 30days was 36.38±7.1pg/mL (range 27.7-46.5) and 60.35±15.94pg/mL (range 38.7-87.2), respectively. The postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found. TOEPVA is a feasible, safe, and reasonable surgical option for patients with hyperparathyroidism, especially those with cosmetic concerns.