Efficacy of gasless trans-subclavian endoscopic parathyroidectomy for primary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIN Ruihao , ZHANG Guowei ,  YUAN Fukang

Department of Thyroid and Hernia Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding?author：

YUAN Fukang, Email: jsbuck520@163.com

Keywords：

gasless; trans-subclavian approach endoscopic parathyroidectomy; primary hyperparathyroidism

DOI：

10.7507/1007-9424.202601019

Video：

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Objective To evaluate the safety, efficacy, and advantages of gasless trans-subclavian approach endoscopic parathyroidectomy (GTAEPT) in the treatment of primary hyperparathyroidism (PHPT). Methods A retrospective analysis was conducted on the clinical data of 10 patients with PHPT who underwent GTAEPT at Xuzhou Central Hospital from October 2022 to September 2024. Data collected included operative time, recurrent laryngeal nerve exposure time, intraoperative blood loss, total drainage volume within the first two postoperative days, total hospital stay, changes in preoperative and postoperative intact parathyroid hormone (PTH) and serum calcium levels, and the occurrence of postoperative complications such as hoarseness, choking during drinking, active bleeding, and surgical site infection. Additionally, PTH and serum calcium levels were monitored at 6-month postoperatively. Results All surgical procedures were successfully completed in the 10 patients. The operative time was (67.0±14.5) min, recurrent laryngeal nerve exposure time was (15.3±8.2) s, intraoperative blood loss was (9.5±3.5) mL, total drainage volume within the first two postoperative days was (36.7±5.2) mL, and total hospital stay was (6.4±1.0) d. The preoperative-to-postoperative differences in PTH and serum calcium levels [mean difference (95%CI)] were 191.3 (160.7, 220.0) ng/L and 0.5 (0.3, 0.6) mmol/L, respectively, both returning to normal reference ranges. Only one case of transient hoarseness was observed postoperatively, with no complications such as active bleeding, choking during drinking, or surgical site infection. At the 6-month follow-up, all patients maintained serum PTH and calcium levels within the normal reference ranges. Conclusions GTAEPT has preliminarily demonstrated safety and feasibility in treating PHPT, with short intraoperative recurrent laryngeal nerve exposure time, rapid postoperative normalization of PTH and serum calcium levels, and stable therapeutic outcomes during the 6-month follow-up. This technique combines the benefits of minimal invasiveness and favorable cosmesis, representing a viable treatment option for patients with unilateral parathyroid lesions.

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2.	中華醫學會內分泌分會代謝性骨病學組. 原發性甲狀旁腺功能亢進癥診療指南. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
3.	Liu YH, Xue LB, Zhang S, et al. Appearance characteristics of incision, satisfaction with the aesthetic effect, and quality of life in of thyroid cancer patients after thyroidectomy. Int J Health Plann Manage, 2021, 36(3): 784-792.
4.	Li W, Li W, Wu P, et al. Endoscopic thyroidectomy via the submental approach: a balanced approach to aesthetics, safety, and recovery—a case series study. Front Endocrinol (Lausanne), 2026, 16: 1715390. doi: 10.3389/fendo.2025.1715390.
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6.	任明, 高國宇, 郭嵩. 納米碳對甲狀腺癌手術中甲狀旁腺的保護作用. 中國普通外科雜志, 2017, 26(11): 1489-1493.
7.	Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6): 875. doi: 10.1002/bjs.1800830656.
8.	孫海清, 鄭海濤. 經口腔前庭入路甲狀腺手術的操作技巧及新進展. 腹腔鏡外科雜志, 2022, 27(3): 161-164.
9.	Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
10.	李帥, 師丙帥, 吳海濱, 等. 雙乳暈入路完全腔鏡下甲狀旁腺腺瘤切除12例臨床分析. 河南外科學雜志, 2020, 26(3): 29-31.
11.	Bhandarwar A, Gala J, Arora E, et al. Endoscopic parathyroidectomy: a retrospective review of 27 cases. Surg Endosc, 2021, 35(3): 1288-1295.
12.	Park JO, Anuwong A, Kim MR, et al. Transoral endoscopic thyroid surgery in a Korean population. Surg Endosc, 2019, 33(7): 2104-2113.
13.	袁芊芊, 賀青卿, 田文, 等. 功能保護性甲狀腺外科: 技術難點與對策. 中國實用外科雜志, 2024, 44(6): 625-629.
14.	楊云飛, 譚宇彥. 內鏡治療原發性甲狀旁腺功能亢進的研究進展. 中國微創外科雜志, 2024, 24(4): 303-308.
15.	趙鑫宇, 代文杰, 喻慶安. 免充氣鎖骨下入路腔鏡甲狀腺手術的研究進展. 中國普外基礎與臨床雜志, 2026, 31(3): 413-420.
16.	Park JO, Lee DH, Kim MR, et al. Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to carbon dioxide gas insufflation: a comparative analysis of 131 cases. Oral Oncol, 2021, 121: 105463. doi: 10.1016/j.oraloncology.2021.105463.
17.	林溪源, 楊曉晴, 王正寨, 等. 多發性甲狀旁腺病變的診斷與治療研究進展. 山東醫藥, 2021, 61(32): 105-109.
18.	Bunch PM, Randolph GW, Brooks JA, et al. Parathyroid 4D CT: what the surgeon wants to know. Radiographics, 2020, 40(5): 1383-1394.
19.	Merchavy S, Luckman J, Guindy M, et al. 4D MRI for the localization of parathyroid adenoma: a novel method in evolution. Otolaryngol Head Neck Surg, 2016, 154(3): 446-448.

1. Bilezikian JP, Bandeira L, Khan A, et al. Hyperparathyroidism. Lancet, 2018, 391(10116): 168-178.
2. 中華醫學會內分泌分會代謝性骨病學組. 原發性甲狀旁腺功能亢進癥診療指南. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
3. Liu YH, Xue LB, Zhang S, et al. Appearance characteristics of incision, satisfaction with the aesthetic effect, and quality of life in of thyroid cancer patients after thyroidectomy. Int J Health Plann Manage, 2021, 36(3): 784-792.
4. Li W, Li W, Wu P, et al. Endoscopic thyroidectomy via the submental approach: a balanced approach to aesthetics, safety, and recovery—a case series study. Front Endocrinol (Lausanne), 2026, 16: 1715390. doi: 10.3389/fendo.2025.1715390.
5. Affleck BD, Swartz K, Brennan J. Surgical considerations and controversies in thyroid and parathyroid surgery. Otolaryngol Clin North Am, 2003, 36(1): 159-187.
6. 任明, 高國宇, 郭嵩. 納米碳對甲狀腺癌手術中甲狀旁腺的保護作用. 中國普通外科雜志, 2017, 26(11): 1489-1493.
7. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg, 1996, 83(6): 875. doi: 10.1002/bjs.1800830656.
8. 孫海清, 鄭海濤. 經口腔前庭入路甲狀腺手術的操作技巧及新進展. 腹腔鏡外科雜志, 2022, 27(3): 161-164.
9. Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
10. 李帥, 師丙帥, 吳海濱, 等. 雙乳暈入路完全腔鏡下甲狀旁腺腺瘤切除12例臨床分析. 河南外科學雜志, 2020, 26(3): 29-31.
11. Bhandarwar A, Gala J, Arora E, et al. Endoscopic parathyroidectomy: a retrospective review of 27 cases. Surg Endosc, 2021, 35(3): 1288-1295.
12. Park JO, Anuwong A, Kim MR, et al. Transoral endoscopic thyroid surgery in a Korean population. Surg Endosc, 2019, 33(7): 2104-2113.
13. 袁芊芊, 賀青卿, 田文, 等. 功能保護性甲狀腺外科: 技術難點與對策. 中國實用外科雜志, 2024, 44(6): 625-629.
14. 楊云飛, 譚宇彥. 內鏡治療原發性甲狀旁腺功能亢進的研究進展. 中國微創外科雜志, 2024, 24(4): 303-308.
15. 趙鑫宇, 代文杰, 喻慶安. 免充氣鎖骨下入路腔鏡甲狀腺手術的研究進展. 中國普外基礎與臨床雜志, 2026, 31(3): 413-420.
16. Park JO, Lee DH, Kim MR, et al. Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to carbon dioxide gas insufflation: a comparative analysis of 131 cases. Oral Oncol, 2021, 121: 105463. doi: 10.1016/j.oraloncology.2021.105463.
17. 林溪源, 楊曉晴, 王正寨, 等. 多發性甲狀旁腺病變的診斷與治療研究進展. 山東醫藥, 2021, 61(32): 105-109.
18. Bunch PM, Randolph GW, Brooks JA, et al. Parathyroid 4D CT: what the surgeon wants to know. Radiographics, 2020, 40(5): 1383-1394.
19. Merchavy S, Luckman J, Guindy M, et al. 4D MRI for the localization of parathyroid adenoma: a novel method in evolution. Otolaryngol Head Neck Surg, 2016, 154(3): 446-448.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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