Minimally invasive parathyroid surgery

Background: Minimally invasive access for the treatment of primary hyperparathyroidism is becoming widespread, but several different approaches have been proposed in the literature. Methods: We describe the three main types of mini-invasive parathyroidectomy, with particular attention to the gasless video-assisted procedure, which is now routinely performed at our institution. Results: Eighty-nine patients with a preoperatively localized single adenoma were successfully treated. Operative time was 58 mins, and there were only five conversions. Discussion: After comparing the different approaches described in literature, we conclude that mini-invasive parathyroidectomy is feasible and can provide additional benefits not available with traditional surgery. At present, however, this operation can be recommended only for patients with sporadic disease, localized lesions, and absence of goiter and prior neck surgery. Received: 8 August 1999/Accepted: 13 December 2000/Online publication: 14 September 2000     

Minimally invasive parathyroid surgery

More surgeons are performing unilateral exploration for primary hyperparathyroidism (HPT) than ever before. This article reviews the factors that have led to the trend toward less invasive surgery. Discussion includes the history of unilateral exploration for HPT, the advent of magnetic resonance sestamibi imaging, and the development of intraoperative assays for parathyroid hormone. Results of minimally invasive techniques, including radio-guided parathyroidectomy, endoscopic parathyroidectomy, and outpatient parathyroidectomy, also are presented.     

Minimally invasive surgery for thyroid and parathyroid diseases

During the past 4 years, some minimally invasive procedures for thyroid and parathyroid surgery have been described. All these techniques have been demonstrated as feasible and safe. Nevertheless, the surgeon should be well trained to obtain the best results with these approaches. Moreover, not all patients are eligible for minimally invasive procedures. At the moment, they can be proposed for most patients with sporadic primary hyperparathyroidism, but only for a minority of patients with thyroid nodules. The results from minimally invasive procedures are almost comparable with those of conventional surgery, but they have additional advantages in terms of cosmetic result and postoperative pain. Therefore, these procedures should be considered a valid option by surgeons dealing with neck endocrine surgery.     

Minimally invasive surgery

Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable. This career resource guides the interested medical student and physician to opportunities for fellowship training in MIS. It includes a discussion of the specialty, training requirements, grant funding, research fellowships, and pertinent societies.     

Minimally invasive spinal surgery

Recent advances in endoscopy, imaging and retractor technology have led to major developments in minimal access surgery of the spine. Their place in practice probably awaits the results of prospective trials.     

Minimally invasive cardiac surgery

Cardiac surgery has been the last of the surgical specialties to embrace the principles of minimal invasiveness. The complexity and invasiveness of the procedures have presented both a problem and an opportunity to make the procedures less invasive. Beginning with initial attempts at coronary artery bypass surgery through limited access with and without robotics, a number of other cardiac procedures currently are being performed by minimally invasive approaches. These include mitral valve repair, transapical aortic valve implant, limited access, and totally endoscopic pulmonary vein isolation for the treatment of atrial fibrillation and the treatment of aortic aneurysmal disease by thoracic endografting. The experience with less invasive surgery in other specialties has served as cross-fertilization for minimally invasive cardiac surgery.     

Minimally invasive nephron-sparing surgery

Open partial nephrectomy, with its excellent 5- and 10-year oncologic follow-up data, is the gold standard against which all other nephron-sparing alternatives must be compared. The evolving minimally invasive nephron-sparing alternatives can essentially be divided into three categories: excision (laparoscopic partial nephrectomy), probe ablation (eg, cryotherapy, radiofrequency ablation), and noninvasive ablation (high-intensity focused ultrasound). A proposed algorithm for the evolving indications of minimally invasive nephron-sparing surgical options is presented in Fig. 23. Currently, by emulating the established techniques of open partial nephrectomy, laparoscopic partial nephrectomy has the most immediate clinical application and relevance. Emerging data support the efficacy and reproducibility of renal cryotherapy. Five-year follow-up data should be available in the near future. Although renal radiofrequency ablation has the potential to further minimize morbidity, serious concerns remain regarding the completeness of cancer cell kill and the reliability of intraoperative monitoring. Noninvasive technologic advancements such as high-intensity focused ultrasound have considerable potential for the future.     

Minimally invasive spinal surgery

Minimally invasive surgery offers quicker recovery and less morbidity for our patients through smaller surgical wounds and less tissue trauma. Although minimally invasive surgery has progressed in other fields of surgery for many years, spine surgeons have not previously embraced this philosophy for the various reasons discussed. However, minimally invasive spinal surgery has gained much interest in recent years. With the advent of new instrumentation, technology, and techniques, the promise of minimally invasive surgery in the spinal arena has become a reality. With the use of the microscope, navigational tools, newly developed canula for retraction, and image-guided percutenous pedicle screw systems, we can accomplish the same surgical procedures as currently used through smaller wounds and with greater precision. Nevertheless, all new technology does offer us an initial challenge of steep learning curves. Minimally invasive should not equate to minimal and inadequate treatment for our patients. Furthermore, careful analysis of this new technique is underway to assess its true advantages as compared with our current and proven techniques.