Ann Thorac Surg 2001;71:402-403
© 2001 The Society of Thoracic Surgeons
Correspondence
Minimally invasive resection of mediastinal parathyroid adenomas
Eduardo A. Tovar, MDa
a Department of Cardiothoracic Surgery, University of California, Irvine Medical Center, 100 E Valencia Mesa Dr, Suite 301, Fullerton, CA 92835, USA
e-mail: etovarmd{at}aol.com
To the Editor
I read with interest the article written by Medrano and colleagues [1], in which they describe 7 patients with an ectopic parathyroid gland removed by this minimally invasive approach. I concur with the authors that open procedures should be avoided when dealing with this pathologic condition. I further agree that VATS provides excellent access to this area, resulting in minimal morbidity and short hospital stay as they clearly demonstrated. As far as alternative minimally invasive routes, the authors indicated the possibility of a transcervical approach or a subxiphoid access, neither of which, according to them, had been reported for the resection of ectopic parathyroid glands. I [2] recently published a transcervical resection (Fig 1) of an aorticopulmonary window parathyroid adenoma that measured 3.5 cm in maximum diameter (Fig 2). The patient met the criteria normally used for an outpatient procedure but was kept in the hospital overnight to monitor calcium levels. Although my report did not appear in an Index Medicus journal and was published after Medrano and associates submitted their article for publication, in it I quoted and referenced a subxiphoid approach [3] published in 1995, and an anterior mediastinal access [4] published in 1991 for resection of mediastinal ectopic parathyroid adenomas. In addition, in the same article I mentioned that in 1976, Freeman and associates [5] referred to transcervical thymectomy as an integral part of neck exploration for hyperparathyroidism.
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Fig 1. Patient 7 days after a transcervical resection of a mediastinal parathyroid adenoma. (Reprinted with permission from Tovar [2].)
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Fig 2. Thymus gland containing a large parathyroid adenoma in the left lower pole removed through a transcervical approach. (Reprinted with permission from Tovar [2].)
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I congratulate Medrano and coauthors for bringing to our attention this interesting topic, their elegant management, and superb results.
References
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Medrano C., Hazelrigg S.R., Landreneau R.J., Boley T.M., Shawgo T., Grasch A. Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 2000;69:221-223.[Abstract/Free Full Text]
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Tovar E.A. Transcervical resection of an aorticopulmonary window parathyroid tumor. Surg Rounds 1999;22:638-640.
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Wei J.P., Gadacz T.R., Weisner L.F., Burke G.J. The subxiphoid laparoscopic approach for resection of mediastinal parathyroid adenoma after successful localization with TC-99m-sestamibi radionuclide scan. Surg Laparosc Endosc 1995;5:402-406.[Medline]
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Schlinkert R.T., Whitaker M.D., Argueta R. Resection of select mediastinal parathyroid adenomas through an anterior mediastinotomy. Mayo Clinic Proc 1991;66:1110-1113.[Medline]
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Freeman J.B., Sherman B.M., Mason E.E. Transcervical thymectomy—an integral part of neck exploration for hyperparathyroidism. Arch Surg 1976;111:359-364.[Abstract/Free Full Text]
Related Article
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Minimally invasive resection of mediastinal parathyroid adenomas: Reply
- Cristina Medrano, Rodney J. Landreneau, Theresa M. Boley, Tilitha Shawgo, Anthony Grasch, and Stephen R. Hazelrigg
Ann. Thorac. Surg. 2001 71: 403.
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