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  • Title
  • 1. Introduction
  • 2. Surgical Approach
  • 3. Dissection
  • 4. Intraoperative PTH Monitoring and Inspection of Anatomy
  • 5. Closure
  • 6. Discussion
  • 7. Post-op Remarks

Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

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Tobias Carling, MD, PhD, FACS
Yale School of Medicine

Procedure Outline

  1. Patient Positioning
  2. Marking
  3. Inject Anesthesia for Local Cervical Block
  1. Kocher Incision
    • Use a 2.5–3.5-cm abbreviated Kocher incision
  2. Create Subplatysmal Flaps
  3. Open Strap Muscles at the Midline
  4. Mobilize Thyroid
    • Mobilize thyroid medially
    • Ligate the middle thyroid vein
    • Retract the thyroid medially
  5. Mobilize Parathyroid Adenoma
    • Identify the left inferior parathyroid adenoma
    • Handle the parathyroid adenoma gently to avoid rupture of the capsule
  6. Ligate End Arterial Blood Supply and Finish Parathyroid Resection
    • Use the silk tie to elevate the parathyroid adenoma out of the tracheoesophageal groove
    • Perform ex vivo aspiration and PTH measurement of the left inferior parathyroid adenoma
    • Measure PTH in the systemic circulation, preoperatively, at the time of excision, and every 5 minutes thereafter
  1. Close Strap Muscles at Midline
  2. Close Platysma Muscles
  3. Close Dermis with 5-0 Prolene
  4. Apply Dermabond and Steri-Strips
  5. Remove Suture

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Authors

Filmed At:

Smilow Cancer Hospital at Yale New Haven

Article Information

Publication Date
Article ID225
Production ID0225.4
Volume2022
Issue225
DOI
https://doi.org/10.24296/jomi/225