Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
Surg Endosc. 2017 Sep;31(9):3755-3763. doi: 10.1007/s00464-016-5397-5. Epub 2016 Dec 28.
Natural orifice transluminal endoscopic surgery developed for neck surgery become increasing popular. Herein, an innovative transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT) and renal hyperparathyroidism (rHPT).
Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars laterally. The subplatysmal space was created down to the sternal notch, and carbon dioxide pressure was insufflated at 6 mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathyroid hormone level and frozen section were conducted. Autotransplantation of the parathyroid gland was performed at the non-dominant forearm in an rHPT patient.
From March 2015 to June 2016, TOEPVA was successfully performed in 12 patients (six PHPT and six rHPT). The mean operative time for parathyroidectomy in PHPT patients was 107.5 min (range 88-127) and 185.8 min in rHPT patients (range 155-214). One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT and the rHPT group at 30 days was 36.38 ± 7.1 pg/mL (range 27.7-46.5) and 60.35 ± 15.94 pg/mL (range 38.7-87.2), respectively. The postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found.
TOEPVA is a feasible, safe, and reasonable surgical option for patients with hyperparathyroidism, especially those with cosmetic concerns.
用于颈部手术的经自然腔道内镜外科技术发展迅速。本文介绍了一种用于原发性甲状旁腺功能亢进症（PHPT）和肾性甲状旁腺功能亢进症（rHPT）的经口内镜下甲状旁腺切除术前庭入路（TOEPVA）。
在下唇下的口腔前庭处做切口。通过口腔前庭中心插入 10mm 套管针，并在其两侧各插入 5mm 套管针。在胸骨切迹下创建皮下平面，并以 6mmHg 的二氧化碳压力充气以维持工作空间。使用腹腔镜器械进行甲状旁腺切除术。术中进行甲状旁腺激素水平和冰冻切片检查。在一名 rHPT 患者中，将甲状旁腺自体移植到非优势前臂。
2015 年 3 月至 2016 年 6 月，TOEPVA 成功应用于 12 例患者（6 例 PHPT 和 6 例 rHPT）。PHPT 患者甲状旁腺切除术的平均手术时间为 107.5 分钟（范围 88-127），rHPT 患者为 185.8 分钟（范围 155-214）。1 例患者出现一过性喉返神经损伤，1 个月内自行恢复。未发现永久性喉返神经损伤。所有患者血清钙水平均恢复正常范围。PHPT 和 rHPT 组患者术后 30 天的甲状旁腺激素水平分别为 36.38±7.1pg/mL（范围 27.7-46.5）和 60.35±15.94pg/mL（范围 38.7-87.2）。术后美容效果极佳。未发现面神经损伤或感染。
TOEPVA 是一种可行、安全、合理的治疗甲状旁腺功能亢进症的手术选择，尤其适用于美容方面有顾虑的患者。
