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Background: Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video-assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem., Methods: Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications., Results: Over a 2-year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60-160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false-positive preoperative imaging., Conclusion: With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma., (© 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)

Introduction: Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, 'persistent disease' is defined as the situation where the patient has not been cured by the first operation. The term 'recurrent hyperparathyroidism' is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence., Methods: Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation., Results: Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease., Conclusions: Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.

Background: This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools. Methods: A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and nonexperts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics. Results: Poor body image was associated with poor scar perception (p = 0.178, p = 0.05). Poor life quality correlated with poor scar perception (p = -0.292, p = 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates. Conclusion: Negative body image and life quality impact negatively upon scar perception. [ABSTRACT FROM AUTHOR]

Background: To undertake a national analysis of clinical activity pattern and outcome of thyroid and parathyroid surgery using bespoke Hospital Episode Statistics data linkage. Methods: Records of patients undergoing thyroid or parathyroid surgery between 2004 and 2012 were obtained. Morbidity was quantified using the Charlson index. Index procedures were linked to the presence of diagnoses and procedures indicative of laryngeal paralysis, regardless of which provider treated the patient. The rate of utilisation of speech and language therapy services in the 18 months before and after thyroid/parathyroid surgery was also calculated. Results: There were 18,931 males and 77,715 females. Mean age at treatment was 52±28 years. Mean length of stay was 2.5 days. There were 75,039 thyroidectomies and 24,234 parathyroidectomies. There were 45,753 benign thyroid conditions, 8519 benign thyroid neoplasms, 17,234 benign inflammatory thyroid conditions, and 9982 thyroid cancers. There were 14,303 benign parathyroid cases, 11,268 benign parathyroid neoplasms, and 199 parathyroid cancers. There were 439 immediate vocal palsies identified. There were 264 cases of immediate airway compromise and 272 tracheostomies were placed. In-hospital mortality occurred in 103 (0.11%) and there were 763 acute cardiac and 533 respiratory events. There were 885 (0.9%) late vocal palsies and mean surgery to diagnosis delay was 577 days. There were 180 vocal medialisations and 555 patients had speech and language therapy. Surgical volume below 25 cases per year and presence of malignant or benign inflammatory thyroid disease increased the risk of laryngeal palsy. Conclusions: Use of Hospital Episode Statistics data for clinical outcomes management is a complex proposition, but through creating and validating data linkages it is possible to obtain a more comprehensive picture of clinical activity, treatment outcomes, and complications. The utility of this data can be further improved through developing a Minimum Coded Dataset Standard (MCDS) to compliment the current national audit. [ABSTRACT FROM AUTHOR]