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Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) for primary hyperparathyroidism: Turkey’s experience

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Abstract

Aim

Parathyroid surgery has witnessed a significant evolution with the introduction of more efficacious preoperative localization imaging techniques and the use of rapid intraoperative parathormone assays. Parathyroid surgery can now be performed with the minimum of invasion. Through the adaptation of the transoral endoscopic thyroidectomy vestibular approach (TOETVA), the technique has now been adopted for parathyroid surgery, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). We present here the initial experiences of 11 centers carrying out TOEPVA surgery in Turkey.

Materials and methods

Participating in the study were 11 centers, all of which were tertiary care institutions carrying out endocrine surgery. A retrospective review was made of 35 primary hyperparathyroidism patients who underwent the TOEPVA procedure between July 2017 and January 2020.

Results

Of the total 35 patients, 32 patients underwent the TOEPVA procedure successfully. All patients but one were female, and the mean age was 47.2 (20–73) years. According to localization studies, 18 of the lesions were lower left, 12 were lower right, 3 were upper right and 2 were upper left. The mean operative time was 116 (30–225) min, and three cases were converted to an open procedure. Simultaneous thyroidectomy was performed in seven cases. The average PTH level dropped to normal within 20 min. after the resection in all cases. The complication rate was 19% (ecchymosis, subcutaneous emphysema, nasal bleeding, surgical site infection and seroma). There were neither recurrent nerve palsies, nor mental nerve root or branch injuries. The average hospital stay was 1 day. No persistence was documented on follow up.

Conclusion

TOEPVA is a “hidden scar” parathyroidectomy procedure that can be safely performed on parathyroid adenomas, in cases that have scar-related concerns. Having its own procedure-related complications, the procedure provides satisfactory objective results, particularly in centers experienced in endoscopic and endocrine surgery.

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Funding

There is not any funding for the study.

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Authors and Affiliations

  1. Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, Izmir, Turkey

    Özer Makay, Murat Özdemir & Yiğit Türk

  2. Division of Endoscopic-Laparoscopic & Minimally Invasive Surgery, Department General Surgery, Suleyman Demirel University Hospital, Isparta, Turkey

    Mehmet Zafer Sabuncuoğlu & İsmail Zihni

  3. Elmali State Hospital, Antalya, Turkey

    Mehmet İlker Turan

  4. Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Ismail Cem Sormaz, Fatih Tunca & Yasemin Giles Şenyürek

  5. Department of General Surgery, Health Sciences University Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey

    Nurcihan Aygün & Mehmet Uludağ

  6. Department of General Surgery, Can Hospital, Izmir, Turkey

    Serhat Buldur

  7. Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey

    Demet Sarıdemir & Cumhur Arıcı

  8. Department of General Surgery, School of Medicine, Trakya University, Edirne, Turkey

    Atakan Sezer

  9. Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Serkan Teksöz

  10. Department of General Surgery, Izmir Katip Çelebi University Hospital, Izmir, Turkey

    Mehmet Hacıyanlı

Authors
  1. Özer Makay
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  2. Mehmet Zafer Sabuncuoğlu
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  3. Mehmet İlker Turan
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  4. Ismail Cem Sormaz
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  5. Murat Özdemir
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  8. Yiğit Türk
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  9. Demet Sarıdemir
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  10. Atakan Sezer
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  13. İsmail Zihni
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  14. Fatih Tunca
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  15. Mehmet Hacıyanlı
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  16. Cumhur Arıcı
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  17. Yasemin Giles Şenyürek
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Corresponding author

Correspondence to Özer Makay.

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Disclosures

Drs. Makay, Sabuncuoglu, Turan, Sormaz, Özdemir, Aygün, Buldur, Türk, Sarıdemir, Sezer, Teksöz, Uludağ, Zihni, Tunca, Hacıyanlı, Arıcı and Giles Şenyürek have no conflicts of interest or financial ties to disclose.

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Makay, Ö., Sabuncuoğlu, M.Z., Turan, M.İ. et al. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) for primary hyperparathyroidism: Turkey’s experience. Surg Endosc 36, 1037–1043 (2022). https://doi.org/10.1007/s00464-021-08368-3

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