Minimally Invasive Parathyroidectomy Under Local Cervical Block Anesthesia for Primary Hyperparathyroidism and Parathyroid Adenoma

1. Introduction

2. Surgical Approach

1. Patient Positioning
2. Marking
3. Inject Anesthesia for Local Cervical Block

3. Dissection

1. Kocher Incision
• Use a 2.5–3.5-cm abbreviated Kocher incision
2. Create Subplatysmal Flaps
3. Open Strap Muscles at the Midline
4. Mobilize Thyroid
• Mobilize thyroid medially
• Ligate the middle thyroid vein
• Retract the thyroid medially
5. Mobilize Parathyroid Adenoma
• Identify the left inferior parathyroid adenoma
• Handle the parathyroid adenoma gently to avoid rupture of the capsule
6. Ligate End Arterial Blood Supply and Finish Parathyroid Resection
• Use the silk tie to elevate the parathyroid adenoma out of the tracheoesophageal groove

4. Intraoperative PTH Monitoring and Inspection of Anatomy

• Perform ex vivo aspiration and PTH measurement of the left inferior parathyroid adenoma
• Measure PTH in the systemic circulation, preoperatively, at the time of excision, and every 5 minutes thereafter

5. Closure

1. Close Strap Muscles at Midline
2. Close Platysma Muscles
3. Close Dermis with 5-0 Prolene
4. Apply Dermabond and Steri-Strips
5. Remove Suture

6. Discussion

7. Post-op Remarks