Optimizing the minimally invasive approach to mediastinal XXXX .

@entity1 @entity3243 @entity2742 @entity3747
BACKGROUND: @entity1 with @entity2742 after neck exploration may have a mediastinal parathyroid gland that has not been identified reliably with a single radiologic study. We report 17 @entity1 who underwent minimally invasive resection for mediastinal @entity3243 after confirmatory multipoint radiologic imaging. METHODS: Fifteen @entity1 underwent thoracoscopic procedures and 2 @entity1 underwent mediastinoscopic procedures for resection of suspected mediastinal @entity3243 . Preoperative localizing studies included sestamibi scan, computed tomography scan of the neck and chest, and selective venous sampling of parathyroid hormone levels. Once a mediastinal location was determined, thoracoscopic or mediastinoscopic resection was performed. Successful removal of parathyroid tissue was confirmed with a 50% or greater reduction in intraoperative parathyroid hormone levels. RESULTS: @entity3243 was resected in 88% of @entity1 after the operation. The cure rate was 100% in @entity1 with two or more concordant studies locating parathyroid tissue in the mediastinum and 60% in those with one positive study. The thoracostomy tube was removed on median postoperative day 1 (range, 0 to 2 days). Median hospital stay was 3 days (range, 2 to 7 days). The most common complication was @entity3747 , which occurred in 18% of @entity1 . CONCLUSIONS: Minimally invasive parathyroidectomy is an effective treatment of @entity2742 caused by mediastinal parathyroid tissue. Targeted exploration depends on the guidance of preoperative localization studies and measurement of intraoperative parathyroid hormone levels to verify successful resection. Selective venous sampling and high-resolution computed tomography scanning can be helpful in @entity1 with negative sestamibi scans.
