Objective To describe the technique and results of minimal access parathyroidectomy using the focused lateral approach (FLA) under local anesthesia with intravenous sedation for excision of posteriorly located parathyroid glands.
Design Review of medical records from a prospectively obtained database of patients.
Setting Tertiary care university hospital.
Patients The records of 88 consecutive patients who underwent parathyroidectomy via FLA between November 13, 2003, and January 26, 2007, were reviewed.
Main Outcome Measures The FLA was used when preoperative sestamibi single-photon emission computed tomography or ultrasonography showed an adenoma located superiorly, posteriorly, or retroesophageally. Intraoperative rapid parathyroid hormone assay was used to confirm a single adenoma in all cases.
Results Eighty cases (91%) were successfully performed under intravenous sedation. In 4 patients, the procedure was converted from a lateral to an anterior approach. Seventy-one patients (81%) were discharged from the hospital the same day. The mean operative times for FLA were 82.6 minutes in the early part of the series and 62.9 minutes in 2006. There were no major complications. One patient experienced transient vocal cord paresis. One patient developed a pneumomediastinum, which resolved without intervention. Another patient developed a small hematoma, which required no treatment and resolved.
Conclusions The FLA is a safe and effective procedure for excision of parathyroid glands that are located superiorly, posteriorly, or retroesophageally. Its major advantage is the ability to remove glands located deep and posterior through a small incision under intravenous sedation. Although there is a learning curve, the overall operative times for minimally invasive parathyroidectomy decreased after experience was gained. The FLA improves the mean excision time for excision of posteriorly located parathyroid adenomas.
