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Case-Controlled Comparison of Video-Assisted and Conventional Minimally Invasive Parathyroidectomy

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Video-assisted parathyroidectomy (VAP) is a new approach to parathyroid exploration for primary hyperparathyroidism (PH). We examined the VAP learning curve and hypothesized that compared with conventional minimally invasive parathyroidectomy (MIS), VAP has similar complication rates and the added benefit of a shorter hospital length of stay. Using a case-control study design, patients with PH with single-focus imaging results undergoing VAP or MIS were compared during a 5-year VAP implementation period. VAP was possible in 18 per cent of patients undergoing initial parathyroid exploration. In comparing 125 VAP cases with 95 MIS control subjects, patients undergoing MIS had higher mean preoperative levels of calcium (P = 0.007) and parathyroid hormone (P = 0.008), greater mean adenoma weight (P < 0.001), and increased long-term mortality (4% MIS vs 0% VAP, P = 0.03). Mean operative time, in-house analgesia use, and operative complications did not differ. The rate of conversion from VAP to MIS was 14 per cent. Patients undergoing VAP were less likely to require an overnight hospital stay (P = 0.01). VAP is a safe surgical option for selected patients with PH, offering improved cosmesis with operative times comparable to conventional MIS. VAP can be done with a low conversion rate even during implementation and allows the added benefit of shorter hospital stay.
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Document Type: Research Article

Affiliations: 1: Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada 2: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 3: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Publication date: January 1, 2012

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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