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Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma

BACKGROUND: Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT). Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy an...

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Autores principales: Tcherveniakov, Peter, Menon, Ashvini, Milton, Richard, Papagiannopoulos, Kostas, Lansdown, Mark, Thorpe, James AC
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2146999/
https://www.ncbi.nlm.nih.gov/pubmed/17937802
http://dx.doi.org/10.1186/1749-8090-2-41
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author Tcherveniakov, Peter
Menon, Ashvini
Milton, Richard
Papagiannopoulos, Kostas
Lansdown, Mark
Thorpe, James AC
author_facet Tcherveniakov, Peter
Menon, Ashvini
Milton, Richard
Papagiannopoulos, Kostas
Lansdown, Mark
Thorpe, James AC
author_sort Tcherveniakov, Peter
collection PubMed
description BACKGROUND: Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT). Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS). We present our experience with the novel use of Video-Assisted Mediastinoscopy (VAM) for resection of ectopic mediastinal parathyroid glands. CASE PRESENTATION: 4 patients underwent VAM for removal of an ectopic intramediastinal parathyroid gland. All of them had at least one previous unsuccessful neck exploration. In all cases histology confirmed complete resection of ectopic parathyroid glands (3 parathyroid adenomas and one parathyroid hyperplasia). Two of the patients required a partial sternal split to facilitate exploration. CONCLUSION: The cervical approach for resection of ectopic parathyroid adenomas is frequently unsuccessful. Previously, the standard surgical approach in such cases was sternotomy and exploration of the mediastinum. Recently, a number of less invasive modalities have been introduced. We found that VAM has several advantages. It has a short theatre time does not require a complex anaesthetic and is performed with the patient in classic supine position utilising often a previous cervical scar with good cosmetic results. It offers a short hospital stay; it is cost effective with minimal use of fancy and pricy consumables with a comfortable incision and no violation of the pleural space. Additionally the use of digital Video imaging has increased the sensitivity of the mediastinoscopy and has added safety and confidence in performing a detailed mediastinal exploration with an additional great training value as well.
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spelling pubmed-21469992007-12-19 Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma Tcherveniakov, Peter Menon, Ashvini Milton, Richard Papagiannopoulos, Kostas Lansdown, Mark Thorpe, James AC J Cardiothorac Surg Case Report BACKGROUND: Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT). Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS). We present our experience with the novel use of Video-Assisted Mediastinoscopy (VAM) for resection of ectopic mediastinal parathyroid glands. CASE PRESENTATION: 4 patients underwent VAM for removal of an ectopic intramediastinal parathyroid gland. All of them had at least one previous unsuccessful neck exploration. In all cases histology confirmed complete resection of ectopic parathyroid glands (3 parathyroid adenomas and one parathyroid hyperplasia). Two of the patients required a partial sternal split to facilitate exploration. CONCLUSION: The cervical approach for resection of ectopic parathyroid adenomas is frequently unsuccessful. Previously, the standard surgical approach in such cases was sternotomy and exploration of the mediastinum. Recently, a number of less invasive modalities have been introduced. We found that VAM has several advantages. It has a short theatre time does not require a complex anaesthetic and is performed with the patient in classic supine position utilising often a previous cervical scar with good cosmetic results. It offers a short hospital stay; it is cost effective with minimal use of fancy and pricy consumables with a comfortable incision and no violation of the pleural space. Additionally the use of digital Video imaging has increased the sensitivity of the mediastinoscopy and has added safety and confidence in performing a detailed mediastinal exploration with an additional great training value as well. BioMed Central 2007-10-15 /pmc/articles/PMC2146999/ /pubmed/17937802 http://dx.doi.org/10.1186/1749-8090-2-41 Text en Copyright © 2007 Tcherveniakov et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Tcherveniakov, Peter
Menon, Ashvini
Milton, Richard
Papagiannopoulos, Kostas
Lansdown, Mark
Thorpe, James AC
Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title_full Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title_fullStr Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title_full_unstemmed Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title_short Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma
title_sort video-assisted mediastinoscopy (vam) for surgical resection of ectopic parathyroid adenoma
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2146999/
https://www.ncbi.nlm.nih.gov/pubmed/17937802
http://dx.doi.org/10.1186/1749-8090-2-41
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