Videothoracoscopic Resection of a Mediastinal Parathyroid Adenoma

Objective: The conventional approach to resection of anterior mediastinal masses is median sternotomy. Advances in thoracoscopy have made it possible to perform excision of mediastinal parathyroid adenoma using minimally invasive techniques. Methods and Procedures: A 67 year old female was found to be hypercalcemic on routine chemistry analysis. Calcium levels were consistently elevated (range between 10.2-12.4) with an intact parathyroid hormone (PTH) of 721 (normal less than 54). Preoperative sestamibi parathyroid scan showed a focal area of intense increased uptake in the anterior mediastinum. CT scan of the chest showed a 2 cm soft tissue nodular mass in the anterior mediastinum. Initial intraoperative PTH level was 575. Results: The patient was placed in a left lateral decubitus position with double lumen intubation and single lung ventilation. Four right-sided thoracic ports were placed (two 10 mm, two 5 mm). A parathyroid adenoma was excised with the thymus gland using the Autosonic shears (U.S. Surgical Corporation). The operative time was 1.5 hours with minimal blood loss and no intraoperative complications. Pathology confirmed an enlarged parathyroid gland (4.2 grams), consistent with adenoma. A repeat intraoperative PTH level 10 minutes following excision of the parathyroid adenoma was 122, which confirmed that all hyperfunctional parathyroid tissue was removed. The patient had an uneventful recovery and was discharged on the first postoperative day. Conclusions: This video demonstrates the technical aspects of resection of a mediastinal parathyroid adenoma by a videothoracoscopic approach. Use of a Video System with Twin Cameras and Picture-in-a-Picture for Laparoscopic Surgery Dennis L. Fowler, MD