Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Ruijin Hospital Gubei Campus, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cancer Med. 2024 May;13(10):e7290. doi: 10.1002/cam4.7290.
This study aimed to establish the standardized procedure of trans-areola single site endoscopic parathyroidectomy (TASSEP), and to compare the performance of TASSEP with that of conventional open parathyroidectomy (COP).
This study enrolled 40 patients with primary hyperparathyroidism (PHPT) who underwent TASSEP, and included 40 of 176 PHPT patients who underwent COP based on propensity score matching. The retrospective analysis was conducted based on prospectively collected data. Perioperative outcomes, including surgical profile, surgical burden and cosmetic results and follow-up were reported. The learning curve was described using a cumulative sum (CUSUM) analysis.
40 TASSEPs were completed successfully without conversions or severe complications. There was no statistically significant difference in operation time between TASSEP and COP groups (80.83 ± 11.95 vs. 76.95 ± 7.30 min, p = 0.084). Experience of 17 cases was necessitated to reach the learning curve of TASSEP. Postoperative pain score and traumatic index (C-reactive protein and erythrocyte sedimentation rate) in TASSEP were apparently lower than those in COP group (p < 0.05). During the proliferation and stabilization phases, TASSEP was associated with significantly better incision recovery and cosmetic scores. Postoperative serum calcium and PTH levels throughout the follow-up period indicated satisfactory surgical qualities in both groups.
Based on precise preoperative localization and intraoperative planning facilitated by three-dimensional (3D) virtual modeling, TASSEP can be feasibly performed on selected patients with satisfactory success rates and low complication rates, providing preferable cosmetic results and alleviating the surgical burden to a certain extent.
本研究旨在建立经乳晕单部位内镜甲状旁腺切除术（TASSEP）的标准化程序，并比较 TASSEP 与传统开放甲状旁腺切除术（COP）的效果。
本研究纳入了 40 例接受 TASSEP 的原发性甲状旁腺功能亢进症（PHPT）患者，并根据倾向评分匹配纳入了 176 例 PHPT 患者中接受 COP 的 40 例患者。对前瞻性收集的数据进行回顾性分析。报告围手术期结果，包括手术概况、手术负担和美容效果以及随访情况。采用累积和（CUSUM）分析描述学习曲线。
40 例 TASSEP 均顺利完成，无中转或严重并发症。TASSEP 组和 COP 组的手术时间无统计学差异（80.83±11.95 与 76.95±7.30 分钟，p=0.084）。完成 TASSEP 的学习曲线需要 17 例经验。TASSEP 组术后疼痛评分和创伤指数（C 反应蛋白和红细胞沉降率）明显低于 COP 组（p<0.05）。在增殖期和稳定期，TASSEP 与切口恢复和美容评分明显改善相关。在随访期间，两组的术后血清钙和 PTH 水平均表明手术质量令人满意。
基于三维（3D）虚拟建模进行精确的术前定位和术中规划，TASSEP 可在选定的患者中安全实施，成功率高，并发症发生率低，可提供更好的美容效果，并在一定程度上减轻手术负担。
