Thoracoscopic removal of ectopic parathyroid adenomas represents a significant advancement in the surgical management of primary hyperparathyroidism, particularly when traditional cervical approaches are unfeasible. At the World Association of Laparoscopic Surgeons (WALS) 2025 conference, Dr. Piyush Kumar Aggarwal shared his insights and experiences on this minimally invasive technique, highlighting its efficacy and safety.

Understanding Ectopic Parathyroid Adenomas

Primary hyperparathyroidism (PHPT) is predominantly caused by parathyroid adenomas. While most are located in typical cervical regions, approximately 25% are ectopically situated in the mediastinum, with about 2% of these cases being inaccessible via standard cervical surgical approaches. citeturn0search1 Accurate preoperative localization is crucial for successful surgical intervention, especially when adenomas are located in challenging areas like the anterior mediastinum.

Advancements in Minimally Invasive Techniques

Historically, mediastinal parathyroid adenomas required sternotomy for removal, a procedure associated with increased morbidity and extended recovery times. The advent of video-assisted thoracoscopic surgery (VATS) has revolutionized this approach, offering a less invasive alternative with reduced postoperative complications. Dr. Aggarwal emphasized that with appropriate preoperative imaging and multidisciplinary collaboration, VATS parathyroidectomy is both effective and well-tolerated. citeturn0search0

Case Studies and Clinical Outcomes

Clinical outcomes have demonstrated the efficacy of thoracoscopic approaches. For instance, a case reported by Apollo Hospitals involved a 33-year-old woman with an ectopic mediastinal parathyroid adenoma. Despite standard localization tests failing to identify the lesion, a C11-Choline PET-CT scan successfully located it in the anterior mediastinum. The adenoma was subsequently excised thoracoscopically, with intraoperative parathyroid hormone (PTH) monitoring confirming successful removal. The patient's postoperative period was uneventful, and she was discharged on the second day. citeturn0search4

Intraoperative Radioguided Techniques

Dr. Aggarwal also highlighted the utility of intraoperative radioguided techniques in enhancing the precision of thoracoscopic resections. In cases where adenomas are not easily visualized, the use of a handheld gamma probe can assist in accurate localization, facilitating successful removal. This approach minimizes the need for conversion to open surgery and reduces operative times. citeturn0search1

Anaesthetic Considerations

The role of anesthesia in thoracoscopic procedures is pivotal. Anesthetic management must address challenges such as maintaining adequate oxygenation during one-lung ventilation and ensuring hemodynamic stability. A case reported in the Indian Journal of Anaesthesia detailed the anesthetic considerations during VATS for a mediastinal ectopic parathyroid adenoma, emphasizing the importance of meticulous intraoperative monitoring and postoperative care to prevent complications like hypocalcemic tetany. citeturn0search2

Dr. Piyush Kumar Aggarwal's Contributions

Dr. Aggarwal, an Associate Consultant at Sri Balaji Action Medical Institute, has extensive experience in minimally invasive surgeries, including thoracoscopic parathyroidectomies. His training encompasses a Post-Doctoral Fellowship in Minimal Access Surgery from prestigious institutions in New Delhi. Throughout his career, Dr. Aggarwal has been involved in various research endeavors, contributing to the advancement of surgical techniques and patient care. citeturn0search3

Conclusion

The thoracoscopic removal of ectopic parathyroid adenomas signifies a paradigm shift in the management of PHPT. Insights from experts like Dr. Piyush Kumar Aggarwal underscore the importance of minimally invasive techniques, multidisciplinary collaboration, and technological advancements in improving patient outcomes. As surgical practices continue to evolve, such approaches offer patients safer procedures with quicker recoveries, marking a significant milestone in endocrine surgery.