Adoption of transoral parathyroid surgery for primary hyperparathyroidism – Analysis of the European TOETVA/TOEPVA Study Group

Abstract Background The introduction of new surgical technologies inevitably requires scrutiny. With the increasing introduction of transoral endoscopic thyroidectomy via the vestibular access (TOETVA) in benign and malignant thyroid surgery, it is imperative to also define the procedure for the parathyroid glands to ensure the clinically safe introduction and use of the Transoral Endoscopic Parathyroidectomy Vestibular Approach (TOEPVA). The aim of this study was to evaluate this technique within the European Transoral Endoscopic Para-/Thyroidectomy Vestibular Approach Study Group. Methods This study included patients who underwent TOEPVA between February 2016 and February 2023 at seven European high-volume tertiary referral centres. The data were analysed regarding the use of preoperative localization procedures, success rates, duration of surgery, complications and type of specimen collection. Results Overall, 29 (90.6%) patients underwent pure TOEPVA. In 3 (9.4 %) patients TOEPVA was combined with hemithyroidectomy. Each European Center performed between 2 and 10 cases. Overall, none cases were identified as 'complex', i.e. including bilateral neck exploration. Cervical ultrasound was performed in all 32 (100 %) patients and yielded a positive result. Tc99mSestaMibi scintigraphy with single positron emission computed tomography (SPECT) was performed in 30 (93.8%) patients, with inconclusive results in two (6.7%) of these patients. Choline positron emission tomography (PET)/computed tomography (CT) was performed in 4 (12.5 %) patients with positive results. Magnetic resonance imaging was not used. The mean operative time was 102 ± 46.9 (range 40 - 260) minutes. The success rate (i.e. normocalcaemia) was 100% on the first postoperative day. One (3.1%) patient had recurrent laryngeal nerve palsy. Conversion to open surgery, revisions and local infections did not occur. The mean hospital stay was 1.75±3 (range 1-3) days. At discharge, 2 (6.3%) patients had local swelling, 3 (9.4%) patients suffered from discolouration in the chin area, one (3.1%) patient had local sensory disturbance but no motor deficit. Conclusion This is the first European report on TOEPVA showing favourable perioperative outcomes for localised pHPT. Further experience and studies are needed to confirm the clinical benefit.