Our Summary

This research paper talks about a relatively new way of doing surgery on the parathyroid glands, which are small glands in the neck that produce a hormone that regulates the amount of calcium in the blood. The new method, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA), is less invasive than traditional surgery and leaves no visible scar.

The study looked at 35 patients who underwent the TOEPVA procedure in Turkey between July 2017 and January 2020. The surgery was successful in 32 of these cases, with only three needing to be converted to an open procedure. The procedure was quicker than traditional surgery, with an average operating time of 116 minutes, and most patients were able to leave the hospital the same day.

The complication rate was 19%, which included issues like bruising, air trapped under the skin, nosebleeds, infection at the surgery site and fluid-filled swelling. However, there were no serious complications like nerve damage.

Overall, the study concluded that the TOEPVA procedure is a safe and effective method for removing parathyroid adenomas (benign tumors) in patients who are concerned about scarring. However, it does come with its own set of potential complications, and is best performed in medical centers with experience in endoscopic and endocrine surgery.

FAQs

  1. What is the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA)?
  2. What is the success rate and complication rate of the TOEPVA procedure?
  3. Who are the best candidates for the TOEPVA procedure?

Doctor’s Tip

A doctor might advise a patient undergoing a parathyroidectomy to carefully follow post-operative instructions, including taking prescribed medications, avoiding strenuous activities, and attending follow-up appointments. They may also recommend discussing any concerns or questions with their healthcare provider to ensure a successful recovery.

Suitable For

Patients who are typically recommended parathyroidectomy include those with hyperparathyroidism, which is a condition where the parathyroid gland produces too much parathyroid hormone. This can lead to high levels of calcium in the blood, causing symptoms such as fatigue, weakness, bone pain, kidney stones, and gastrointestinal issues. Parathyroidectomy may also be recommended for patients with parathyroid adenomas or other benign or malignant tumors of the parathyroid glands. Additionally, patients who have not responded to other treatments for hyperparathyroidism may be candidates for parathyroidectomy.

Timeline

Before the parathyroidectomy:

  • Patient experiences symptoms of hyperparathyroidism, such as fatigue, weakness, bone pain, kidney stones, and frequent urination.
  • Patient undergoes blood tests to diagnose hyperparathyroidism and imaging tests to locate the affected parathyroid gland.
  • Patient consults with an endocrine surgeon to discuss treatment options, including traditional parathyroidectomy or the newer TOEPVA procedure.
  • Patient undergoes preoperative evaluations and preparation for surgery.

After the parathyroidectomy:

  • Patient undergoes the TOEPVA procedure, which is less invasive and leaves no visible scar.
  • Surgery is successful in removing the parathyroid adenoma in most cases, with only a small percentage needing to be converted to an open procedure.
  • Patient experiences a quicker recovery time, with most able to leave the hospital the same day.
  • Patient may experience minor complications such as bruising, air trapped under the skin, nosebleeds, infection at the surgery site, and fluid-filled swelling, but no serious complications like nerve damage.
  • Patient follows up with the surgeon for postoperative care and monitoring of calcium levels in the blood to ensure proper regulation.
  • Patient experiences relief from symptoms of hyperparathyroidism and improved overall health and quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about parathyroidectomy, specifically the TOEPVA procedure, include:

  1. What are the potential risks and complications associated with the TOEPVA procedure?
  2. How experienced are you in performing the TOEPVA procedure, and what is your success rate with this method?
  3. Will I need to stay in the hospital overnight after the surgery, or can I go home the same day?
  4. How long is the recovery process after a TOEPVA procedure, and when can I expect to return to normal activities?
  5. Are there any specific post-operative instructions or restrictions I should follow to ensure a successful recovery?
  6. Will I need to take any medications or undergo any follow-up tests after the surgery?
  7. How will my calcium levels be monitored after the removal of the parathyroid adenomas?
  8. Are there any potential long-term effects or complications I should be aware of following a parathyroidectomy?
  9. Can you provide me with information about your experience and success rate with the TOEPVA procedure, as well as any alternative treatment options?
  10. What kind of scarring, if any, can I expect after the TOEPVA procedure, and how can it be minimized or treated?

Reference

Authors: Makay Ö, Sabuncuoğlu MZ, Turan Mİ, Sormaz IC, Özdemir M, Aygün N, Buldur S, Türk Y, Sarıdemir D, Sezer A, Teksöz S, Uludağ M, Zihni İ, Tunca F, Hacıyanlı M, Arıcı C, Giles Şenyürek Y. Journal: Surg Endosc. 2022 Feb;36(2):1037-1043. doi: 10.1007/s00464-021-08368-3. Epub 2021 Mar 3. PMID: 33660120