Endoscopic Lateral Parathyroidectomy

Improvement in imaging studies for parathyroid localization and the use of intraoperative parathyroid hormone (PTH) determinations in patients treated for primary hyperparathyroidism has allowed the development of minimally invasive and endoscopic approaches for parathyroid disease. Endoscopic approach for parathyroid disease was first described by Michel Gagner et al. in 1996 [1]. Subsequently, other approaches describing video-assisted and endoscopic approaches were described and reproduced successfully [2–5]. Endoscopic parathyroidectomy with the lateral approach (EPLA) was first described by Henry et al. in 1999 [6]. While the video-assisted approach described by Miccoli et al. [3] used the endoscope to assist in the dissection and excision of the adenoma, Henry developed a “pure” endoscopic approach, using low CO2 pressure and a special set of 3-mm trocars and instruments designed and manufactured by him specifically for this purpose. In 2006, his team published his cohort of 449 patients operated by this approach, reporting a mean operative time of 48 minutes and a 13.4% conversion rate to traditional cervicotomy, with almost identical complication rates when compared to the traditional approach. This technique was described as the main surgical approach for patients operated in his group (56.6%) [7]. Aside from the cosmetic results, the technique profits from the magnification provided by the endoscope, which allows for improved visual identification of the diseased gland, its pedicle, the recurrent laryngeal nerve, and the ipsilateral inferior or superior parathyroid gland, irrespective of their location along the lateral aspect of the thyroid gland and upper mediastinum [8, 9].