Minimally Invasive Video-Assisted Parathyroidectomy

The great improvement of preoperative studies able to correctly localize an affected parathyroid in cases of primary hyperparathyroidism, and the increased availability of intraoperative PTH, have led to a different surgical approach to hyperparathyroidism. The surgical strategy has moved from the bilateral exploration of the parathyroids to a “focused” parathyroidectomy, indicated for the majority of cases, that allows to limit the surgical dissection, the time of the procedure, and the morbidity. Among all the minimally invasive techniques conceived to this purpose, the Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) was designed and described in Pisa, in 1997. The technique relies on principles that are different from those of the totally endoscopic techniques: the access is a single central 1.5 cm incision performed in the anterior part of the neck (thus allowing an approach to both sides of the neck), the CO2 insufflation is not used since the surgical field is maintained by external retraction, but the endoscope is still used to explore the anatomical region. The purposely designed surgical instruments and the endoscope are all inserted from the incision, allowing to perform a thorough exploration of the neck, with the great advantage of the endoscopic vision, and an oncologically correct dissection and removal of the parathyroid tissue. The significant advantages of the MIVAP over other techniques might be summarized in: the same outcomes of the traditional surgery, obtained with a better cosmetic result and postoperative course, and the possibility of performing a bilateral exploration when necessary, theoretically allowing to avoid preoperative localizing studies and the use of intraoperative PTH.