Thoracoscopic Management of Ectopic Parathyroid Adenoma – At WALS 2025 by Dr. Piyush Kumar Aggarwal

Introduction

Ectopic parathyroid adenomas pose a unique challenge in the field of endocrine surgery due to their variable anatomical locations and potential for severe hyperparathyroidism. Traditional surgical approaches, such as open neck exploration and sternotomy, often involve increased morbidity and longer recovery times. However, with the advent of minimally invasive techniques, thoracoscopic surgery has emerged as a revolutionary approach to managing ectopic parathyroid adenomas located in the mediastinum. At the prestigious World Association of Laparoscopic Surgeons (WALS) 2025 conference, Dr. Piyush Kumar Aggarwal presented his groundbreaking work on the thoracoscopic management of ectopic parathyroid adenoma, highlighting its efficacy, safety, and advantages over conventional methods.

Understanding Ectopic Parathyroid Adenoma

The parathyroid glands are typically located behind the thyroid gland, but in about 10% of cases, one or more glands may be ectopically located due to aberrant migration during embryological development. Ectopic parathyroid adenomas most commonly occur in the mediastinum, thymus, pericardium, or along the carotid sheath. These adenomas can lead to primary hyperparathyroidism (PHPT), causing excessive secretion of parathyroid hormone (PTH), which in turn leads to hypercalcemia, osteoporosis, kidney stones, and neuropsychiatric symptoms.

While conventional imaging techniques like sestamibi scans, ultrasound, and CT scans can help localize these adenomas, surgical removal remains the definitive treatment. However, due to their deep-seated location, thoracoscopic techniques offer a less invasive alternative to traditional sternotomy or thoracotomy.

Thoracoscopic Approach: A Game-Changer in Surgical Treatment

Dr. Piyush Kumar Aggarwal, a leading expert in minimally invasive surgery, presented his experience and research on the thoracoscopic management of ectopic parathyroid adenomas at WALS 2025. His presentation focused on the advantages, procedural techniques, and outcomes of this approach.

1. Advantages of Thoracoscopic Surgery
- Minimally Invasive: Unlike open thoracotomy, thoracoscopy requires only small incisions, reducing postoperative pain and scarring.
- Faster Recovery: Patients experience shorter hospital stays and faster return to daily activities.
- Better Cosmetic Outcomes: Small incisions mean minimal visible scarring.
- Improved Precision: High-definition cameras provide superior visualization of the mediastinal structures, aiding in precise adenoma removal.

2. Surgical Technique
Dr. Aggarwal demonstrated a step-by-step approach to thoracoscopic parathyroidectomy:
- Preoperative Localization: Accurate imaging with 4D-CT scans, sestamibi scintigraphy, and intraoperative PTH monitoring ensures precise identification of the adenoma.
- Patient Positioning: The patient is placed in a lateral decubitus position to allow optimal access to the mediastinum.
- Port Placement: Three to four small incisions (5-10 mm) are made to introduce a thoracoscope and surgical instruments.
- Adenoma Identification and Resection: Using meticulous dissection techniques, the ectopic parathyroid adenoma is identified, excised, and removed via an endoscopic retrieval bag.
- Intraoperative PTH Monitoring: PTH levels are measured before and after resection to confirm successful removal.

3. Clinical Outcomes and Success Rates
Dr. Aggarwal's findings from a multi-institutional study demonstrated a high success rate (>95%) with minimal complications. Patients had lower rates of postoperative pain, a significant decrease in PTH levels, and faster recovery times compared to those undergoing open surgery. His research further highlighted the low recurrence rates and improved quality of life in patients who underwent thoracoscopic surgery.

The Impact of Dr. Aggarwal’s Research on Endocrine Surgery

Dr. Piyush Kumar Aggarwal’s pioneering work at WALS 2025 has set a new standard for managing ectopic parathyroid adenomas. His research underscores the importance of adopting minimally invasive techniques in endocrine surgery, not only to improve surgical outcomes but also to enhance patient satisfaction. The thoracoscopic approach is expected to gain widespread acceptance and may soon become the gold standard for treating mediastinal ectopic parathyroid adenomas.

The discussion at WALS 2025 also emphasized future advancements in robot-assisted thoracoscopic surgery (RATS), which could further refine the procedure by offering greater dexterity, precision, and three-dimensional visualization.

Conclusion

The thoracoscopic management of ectopic parathyroid adenomas, as presented by Dr. Piyush Kumar Aggarwal at WALS 2025, marks a significant advancement in endocrine and minimally invasive surgery. His work highlights the efficacy, safety, and superior patient outcomes associated with this approach, paving the way for wider adoption in clinical practice. As technology and surgical techniques continue to evolve, the future of minimally invasive parathyroid surgery looks promising, offering patients safer and more effective treatment options.