Cervical approach by lifting the superior sternum for mediastinal parathyroid adenoma.

We report our experience with sternum lifting method in 5 patients with a retrosternal large parathyroid gland around an innominate vein. There were 2 men and 3 women aged 35 to 81 years. All patients showed a retrosternal large parathyroid gland around an innominate vein. Under general anesthesia, the patient is placed in a supine position with the neck extended. About 3 to 4 cm cervical incision is made above the sternal notch. Two hooks are placed at both sternoclavicular junctions. After the sternum is retracted upward, the anterior mediastinum can now be well visualized with the surgeon at the head of the table. When the direct vision is not clear, using the video imaging provides the physician with a clear, magnified view of the area under deep sternum. All patients underwent complete cervical excision using our method without any complications. The average operative time was 61 minutes and blood loss was minimal. Excellent postoperative outcomes were observed. The patients had no pain or other complications. All patients were discharged 4 days after the surgery. We believe that cervical excision using our method is a better alternative in those patients with anterior mediastinal parathyroid glands around an innominate vein.