Operative time and postoperative pain following minimally invasive video-assisted parathyroidectomy.

BACKGROUND

Mininvasive surgical techniques have been proposed to treat the patients affected by parathyroid adenoma starting by endoscopically-assisted parathyroidectomy up to video-assisted and radio-guided approaches.

PATIENTS AND METHODS

Our technique, minimally invasive video-assisted parathyroidectomy (MIVAP), in accord with Miccoli's technique, has been introduced in our center since 2006 after extensive experience with MIVAT (minimally invasive videoassisted thyroidectomy). From September 2006 to October 2008 we performed 32 MIVAP on 32 patients, 21 female and 11 males with a mean age of 53.4 years (range 25-77) affected by parathyroid adenoma. Patients have been divided in two groups in chronological order: Group A included the first 15 patients, Group B the second ones.

RESULTS

Mean operative time from incision to skin closure has been 47.4+/-14.2 minutes for group A and 34+/-10.3 minutes for group B (p<0.01). Postoperative pain, scored from 0 to 10 evaluated at time 0 and after 24 hours from the procedure, has been of 2.6+/-0.5 and 1.4+/-0.5 in group A (p<0.001) while in group B of 2.58+/-0.51 and 1.16+/-0.38 (p<0.001) respectively. The difference in postoperative pain was not significant between the two groups and the pain was controlled by the administration of paracetamol 1 g. On the other side, the comparison between postoperative pain in patients operated via traditional bilateral cervical exploration and MIVAP (2.61+/-0.5 vs 3.55+/-0.51 and 1.38+/-0.5 vs 2.16+/-0.61 at 0 and 24 hours respectively), was statistically significant (p<0.001) and in favour of MIVAP.

CONCLUSIONS

We showed a shorter operative time between the A group and B group. 15 cases are sufficient as good learning curve if the surgeon is experienced in videoassisted neck procedure. The postoperative pain is lower in videoassisted procedure than cervical bilateral approach.