The subxiphoid laparoscopic approach for resection of mediastinal parathyroid adenoma after successful localization with TC-99m-sestamibi radionuclide scan.

Primary hyperparathyroidism is caused by an ectopically located parathyroid adenoma in a small percentage of cases. Parathyroid adenomas located within the retrosternal area of the anterior mediastinum account for a large proportion of failed initial cervical explorations. Current surgical approach to these lesions is via median sternotomy, with the discomfort, hospitalization, and morbidity associated with a major thoracic operation. We report a new technique for the resection of these ectopic parathyroid adenomas after successful radiologic localization: a minimally invasive subxiphoid laparoscopic approach. The procedure was performed in a symptomatic patient with documented primary hyperparathyroidism who had failed three previous neck operations. The ectopic parathyroid adenoma was successfully resected endoscopically, with resolution of the hypercalcemia. The patient was discharged on the third postoperative day, avoiding completely the morbidity of a median sternotomy.