Our Summary

This research paper reviews a new surgical method called Transoral Endoscopic Parathyroidectomy Vestibular Approach (TOEPVA), which is performed through the mouth to treat issues with the parathyroid glands. The researchers looked at studies related to this surgery to see how safe and effective it is.

They found nine studies with a total of 78 cases where TOEPVA was performed. The surgery was successful in 96% of the cases and there were very few complications. Only three patients (3.8%) had complications, including one case where the patient had temporary trouble with their laryngeal nerve, which controls the vocal cords.

However, the quality of the studies they found was only moderate, which means there might be some bias in the results.

In simpler terms, this paper is saying that based on the available evidence, it appears that TOEPVA is a safe and effective surgery for carefully selected patients. However, more high-quality studies are needed to be certain.

FAQs

  1. What is the Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) and why is it gaining popularity?
  2. What was the success rate and the complication rate for TOEPVA according to the systematic review?
  3. What is the need for further large-scale studies on TOEPVA as suggested in the conclusions of the review?

Doctor’s Tip

A helpful tip a doctor might tell a patient about parathyroidectomy is to follow post-operative care instructions closely, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities. It is also important to report any unusual symptoms or complications to your healthcare provider promptly.

Suitable For

Patients with primary hyperparathyroidism who have a single adenoma or hyperplasia of the parathyroid gland are typically recommended for parathyroidectomy. Additionally, patients who have failed medical management or have symptoms such as kidney stones, osteoporosis, or fatigue may also be candidates for parathyroidectomy. Patients who are not suitable candidates for traditional open surgery may benefit from minimally invasive approaches such as TOEPVA.

Timeline

Before parathyroidectomy:

  1. Patient presents with symptoms of hyperparathyroidism such as fatigue, bone pain, kidney stones, and changes in mental status.
  2. Patient undergoes diagnostic tests such as blood tests, ultrasound, and sestamibi scan to localize the abnormal parathyroid gland.
  3. Once the abnormal gland is identified, the patient is scheduled for parathyroidectomy.

After parathyroidectomy:

  1. Patient undergoes TOEPVA surgery, a minimally invasive remote-access scarless surgery.
  2. The surgery is successful in 96% of cases, with low complication rates.
  3. Patient may experience temporary side effects such as transient recurrent laryngeal nerve palsy.
  4. Patient is monitored post-operatively for any complications and undergoes follow-up tests to ensure successful removal of the abnormal parathyroid gland.
  5. Patient experiences relief from symptoms of hyperparathyroidism and a restoration of normal calcium levels in the body.

What to Ask Your Doctor

  1. What is a parathyroidectomy and why do I need one?
  2. What are the risks and benefits of the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) compared to traditional surgical approaches?
  3. How experienced are you in performing TOEPVA procedures?
  4. What is the success rate of TOEPVA for my specific case?
  5. What are the potential complications of TOEPVA and how are they managed?
  6. What is the recovery process like after TOEPVA compared to traditional surgery?
  7. Are there any specific criteria that make me a good candidate for TOEPVA?
  8. How long will I need to stay in the hospital after the procedure?
  9. Will I need to take any medication or follow any specific guidelines after the surgery?
  10. What are the long-term outcomes and follow-up care needed after a TOEPVA procedure?

Reference

Authors: Entezami P, Boven L, Ware E, Chang BA. Journal: Am J Otolaryngol. 2021 Jan-Feb;42(1):102810. doi: 10.1016/j.amjoto.2020.102810. Epub 2020 Oct 25. PMID: 33202327