Removal Of Ectopic Parathyroid Adenomas In Aortopulmonary Window With Minimal Invasion Techniques
Francina Bolanos1, Susana López Alamillo2, Julio de Jesus Herrera Zamora1, Luis Fernando Arana Bolaños1, José Alfredo Santibañes3, Patricio Javier Santillán Doherty1.
1instituto Nacional de Enfermedades Respiratorias INER, Mexico, Mexico, 2Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Mexico, Mexico, 3instituto Nacional de Enfermedades Respiratorias INER, mexico, Mexico.
BACKGROUND:Primary hyperparathyroidism (pHPT) is a disease that may be caused by parathyroid adenomas and it is infrequently associated with ectopic parathyroid glands. The rationale use of video-assisted thoracoscopic surgery (VATS) for the surgical resection of these ectopic parathyroid adenomas at a tertiary-care center is herein reported. METHODS: A rare case series of 3 patients undergoing VATS to treat single ectopic parathyroid gland in the aortopulmonary window in a period of 10 years in our institution is described. labs, surgical strategy and outcomes and pathological analysis were included. RESULTS:Three cases of mediastinal parathyroid adenomas located in the aortopulmonary window causing tertiary hiperparatiroidism in the patients. All of these patients were female with a median age of 54 years old (range 51-59 years). Ectopic parathyroid glands communes are found in various locations along the neck. Uncommon locations include the retro/paraesophageal space, the mediastinum, intrathymic or intrathyroidal, within the carotid sheath and/or a high-undescended cervical position is rare 1-2%. Approximately 16% of patients with pHPT have an ectopic parathyroid gland and up to 2% of hyperfunctioning parathyroid adenomas are not accessible by a standard cervical surgical, before the introduction of VATS or RATS ectopic parathyroid glands in mediastinum were removed by thoracotomy or a median sternotomy incision. Undoubtedly VATS provide significant and obvious advantages over the previously mentioned approaches. CONCLUSION: Ectopic parathyroid glands are not commonly found in mediastinum and 1-2% of the cases are located aortopulmonary window, approximately 2% of the glands are hyperfunctioning and produce primary hyperparathyroidism. The main surgical approach for this location is with VATS in supine decubitus or lateral right decubitus
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