Transoral parathyroidectomy in primary hyperparathyroidism—initial results of the European TOETVA/TOEPVA Study Group

Summary Background New surgical technologies inevitably require scrutiny. With the increasing introduction of transoral endoscopic thyroidectomy via vestibular access (TOETVA), 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). This study aimed to evaluate this technique in preoperatively localized solitary parathyroid adenomas, which seem to be appropriate targets for transoral surgery due to their small size and the expected simplicity of removal via transoral access 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 centers. Patients with sporadic primary hyperparathyroidism, with positive preoperative localization, and without previous neck surgery or radiation were included. The data were analyzed 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. Cervical ultrasound (US) was performed for all 32 patients and yielded a positive result. Tc 99m sestamibi scintigraphy with single-positron-emission computed tomography (SPECT) was performed for 30 (93.8%) patients. Choline positron-emission tomography (PET)/computed tomography (CT) was performed for 4 (12.5%) patients with positive results. The mean operative time was 102 ± 46.9 (range 40–260) min. The success rate was 100% on the first postoperative day. One (3.1%) patient had recurrent laryngeal nerve palsy. Conversion to open surgery, revision surgery, or local infection did not occur. At discharge, 2 (6.3%) patients had local swelling, 3 (9.4%) had discoloration in the chin area, and 1 (3.1%) patient had local sensory disturbance but no motor deficit. Conclusion This is the first European report on TOEPVA presented by the European TOETVA/TOEPVA Study Group. In accordance with the results of other study groups, our results show that TOEPVA performed by experienced endocrine surgeons is a safe alternative to conventional surgery, with results, complication rates, and success rates comparable with and equal to focused conventional parathyroid surgery in localized primary hyperparathyroidism. However, further experience and studies are needed to confirm the clinical benefit of this technique.