Video-assisted parathyroidectomy (VAP), as other minimally invasive techniques, has been already validated for the treatment of most patients with sporadic primary hyperparathyroidism (sPHPT). VAP is usually proposed for well localized parathyroid adenomas. Conventional bilateral neck exploration has still a role in case of uncertain preoperative localization or multiglandular disease. Nevertheless, contrary to other procedures, VAP combines the advantage of a minimal access with the possibility to perform a complete bilateral neck exploration, when localization is uncertain or intraoperative quick PTH assay unavailable, and, when necessary, also for associated thyroid resections (VANE = video-assisted neck exploration).

Fifteen patients with sPHPT underwent VANE and were included in this study. Patients were selected because of inadequate preoperative localization of parathyroid adenoma in 8 cases, unavailability of quick intraoperative PTH assay in 2 cases and concomitant video-assisted bilateral thyroid resection (total thyroidectomy) in the remaining 5. Bilateral neck exploration was performed through a 1.5-cm central skin incision between the cricoid cartilage and the sternal notch. A 30° 5 mm endoscope and the other endoscopic instruments were inserted through the same incision, without any trocar utilization, as already described for VAP.

VANE allowed for the exploration of four glands in all the cases. A single enlarged parathyroid gland was identified and removed in all the cases. Final histology confirmed the diagnosis of parathyroid adenoma in all the cases. Eight patients underwent concomitant video-assisted thyroid resections. The mean operative time was 70 min (range: 50-120 min). Serum calcium and PTH levels measured in I and II postoperative days were within the normal range. No postoperative complication was observed. Postoperative stay was two days in all cases. Cosmetic results was considered excellent by all the patients. No evidence of persistent or recurrent disease was found at a mean follow-up of 13 months.

VANE is feasible, safe and can be associated with video-assisted thyroid resection, when necessary. Even if its long-term results still need to be compared to those of the conventional procedure, VANE represents an attractive and promising minimally invasive alternative to conventional surgery in case of sPHPT with uncertain preoperative localization or in case of multiglandular disease.