Endoscopic Parathyroid Surgery
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Endoscopic Parathyroid Surgery
- 1. Endoscopic Parathyroid Surgery Danny Yacoub MD George Ferzli MD, FACS Professor of Surgery, SUNY SUNY Downstate Medical Center Lutheran Medical Center
- 4. The Legacy of Ivar Sandstrom (1852–1889) I.V. Sandstrom, On new gland in man and several mammals, Bull Inst Hist Med 6 (1938), pp. 192–222.c
- 9. Minimally Invasive Parathyroid Surgery
- 10. Why MIVAP? …Cosmetic Results Open surgery scar Minimally invasive / endoscopic scars
- 12. MIVAP-Results
- 17. Parathyroid Locations Possible locations of enlarged parathyroid glands in the neck and superior mediastinum with the use of an anteroposterior projection (A) and a lateral projection (B) Udelsman R. Ann Surg 244:471-479, 2006
- 20. Sestamibi Ectopic Adenoma Hyperplasia
- 22. Intra operative PTH assay. Prospective 361 consecutive patients undergoing minimally invasive parathyroidectomy. Hwang RS et al. Ann Surg 2010;251:1122-1126. 1- There is no role for IOPTH for Sestamibi positive patients. 2- It will guide the surgeon in Sestamibi negative / positive sonogram patients: In these cases an inadequate fall in the 10- minute post excision PTH level was highly predictive of multi glandular disease. A Selective Bayesian approach to Intraoperative PTH monitoring. A Rising IoPTH Level Immediately after Parathyroid Resection Are Additional Hyperfunctioning Glands Always Present? An application of the Wisconsin Criteria. Cook MR et al Ann Surg 2010;251 1127-1130. 797 consecutive patients. 108 (14%) had a rising ioPTH 5 min after resection of a single parathyroid gland, 36 (33%) continued to have elevated levels and further exploration revealed additional hyperfunctioning glands. In 72 (67%) the ioPTH started to drop within 20 min of gland resection and in all cases correctly predicted operative success. IOPTH / Sonogram
- 23. CT Sestamibi Fusion Scan
- 25. CT Guidance
- 27. MIVAT
- 31. Racial Disparity / Double Adenoma Non-African Americans 21 (5.1%) African Americans 14 (12.4%)
- 38. MIVAP -Technique
- 46. Robotic Approach Arm 1 Camera Arm 2 Arm 3 This approach was developed in South Korea by Dr. Woong Chung at Yonsei University College of Medicine in Seoul. He reported his experience with 338 patients
- 47. Confidential
- 49. Confidential
- 50. Confidential
- 51. Fourth arm trocar External retractor Connected with continuous suction system
- 52. Maryland dissector Harmonic curved shears
- 53. Confidential
Hinweis der Redaktion
- I wound introduce some common scarless approach
- A 4~6cm sized vertical skin incision is made in the axilla
- The dissection is proceeded using the retractors
- To keep a working space, an external retractor is inserted through the skin incision in the axilla and is raised using a lifting device. A second skin incision (0.8cm in length) is made on the medial side of the anterior chest wall for the insertion of the fourth robot arm; apart 2cm superiorly, and 6~8cm medially from the nipple.
- Four robotic arms are used for the operation. Three arms are inserted through the axillary incision, the dual channel endoscope is placed on the central arm, and the Harmonic curved shears along with the Maryland dissector is placed on both lateral side arms of the scope. The prograsp forceps is inserted through the anterior chest arm.