Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Background After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical diseases. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have led to the development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Patients who undergo TOEPVA at our institution between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Results Seven patients were operated successfully by this technique, none of which required conversion to conventional open surgery. Two patients required atropine and one patient required ephedrine during insufflation. Conclusion After induction of anesthesia with propofol, remifentanil, and rocuronium and anesthesia managed by desflurane co-administered with continuous infusion of remifentanil provide feasible and safe anesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anesthetist has a great value to improve patient management.

Remote access endoscopic parathyroidectomy: a study of 17 cases from Central India

<p><strong>Background: </strong>It has been debated that "remote access endoscopic parathyroidectomy" requires extensive dissection, thereby, increasing the risk of complications. Hence, the aim of this study is to assess the feasibility and safety of remote access endoscopic parathyroidectomy via the unilateral axilla-breast approach (ABA) and transoral vestibular approach (TOEPVA). </p><p><strong>Method: </strong>The study includes 17 patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy from January 2016 to December 2020. Of these, 11 patients underwent parathyroidectomy via unilateral ABA and 6 had TOEPVA. Preoperatively, ultrasonography of neck, sestamibi scan and CT scan neck were done to localise the diseased gland. Post operatively, Serum calcium and parathyroid hormone levels were monitored.</p><p><strong>Results</strong>: The mean age of patients was 35.6±10.5 years. Except one, all the patients were females. The mean operative time of the unilateral ABA and TOEPVA group was 93.67±28.64 minutes and 138.6±31 minutes respectively. Except for three patients, in all the patients, the parathormone levels normalised. One patient had hungry bone syndrome postoperatively. The mean hospital stay of the unilateral ABA and TOEPVA group was 3±1.5 days and 4±3.09 days respectively. One patient had post-operative transient recurrent laryngeal nerve paresis. Seroma and surgical emphysema were seen in two patients each. </p><p><strong>Conclusions</strong>: Remote Access Endoscopic parathyroidectomy may be considered safe in treatment of parathyroid tumours. Precise preoperative localisation is mandatory. In addition to a magnified view and a better illumination, the potential advantages of endoscopic techniques are better cosmetic results, decreased hospital stay and better patient comfort.</p>

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Introduction: After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical disease. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have been led to development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anaesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Material-method: Patients undergo TOEPVA at the Health Sciences University Izmir Bozyaka Training and Research Hospital between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Seven patients were operated successfully by this technique none of which required conversion to conventional open surgery. Two patient required atropine and one patient required ephedrine during insufflation. Conclusion: After induction of anaesthesia with propofol, remifentanil and rocuronium; anaesthesia managed by desflurane co-administered with continous infusion of remifentanil, provide feasible and safe anaesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anaesthetist have a great value to improve patient management.