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Minimally Invasive Parathyroidectomy under Local Cervical Block

Tobias Carling, MD, PhD, FACS
Yale School of Medicine
  1. Introduction
  2. Patient Positioning
    1. Surgical Approach and Marking
    2. Injection of Local Anesthesia for Cervical Block
  3. Dissection
    1. Perform 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 to Parathyroid
      • Use the silk tie to elevate the parathyroid adenoma out of the tracheoesophageal groove
  4. Intraoperative PTH Monitoring
      • Perform ex vivo aspiration and PTH measurement of the left inferior parathyroid adenoma
      • Measure PTH in the systemic circulation, preoperatively, at time of excision, and every 5 minutes thereafter
  5. Closure
    1. Close Strap Muscles
    2. Close Platysma Muscles
    3. Close Dermis with 5-0 Prolene
    4. Apply Dermabond and Steri-Strips
    5. Remove Suture
  6. Discussion