[Comparative study of the efficacy of subclavian space endoscopic approach and anterior cervical open surgery for the treatment of hyperparathyroidism].

Objective

To investigate the clinical value of thoracoscopic partial parathyroidectomy via the subclavian approach for the treatment of parathyroid adenoma with primary hyperparathyroidism.

Methods

A retrospective analysis was conducted on 26 patients with parathyroid adenoma and primary hyperparathyroidism treated between September 2023 and April 2024. Patients were divided into two groups based on surgical approach: the thoracoscopic subclavian approach group and the median anterior cervical open approach group. Multiple indicators, including perioperative parameters, postoperative complications, postoperative pain, and incision cosmetic satisfaction, were compared and analyzed. The clinical efficacy of thoracoscopic partial parathyroidectomy via the subclavian approach was evaluated.

Results

All surgeries were completed successfully. There were significant differences between the two groups in terms of operative time and intraoperative blood loss（P=0.001,<0.001）, while there were no statistically significant differences in age, lesion size, preoperative/postoperative serum parathyroid hormone（PTH）, preoperative/postoperative serum calcium, postoperative drainage volume, drainage tube placement time, length of hospital stay, and cost（all P>0.05）. At 24 hours postoperative serum PTH and calcium concentrations were significantly decreased compared to preoperative levels（P=0.012,<0.001; P=0.018,<0.001）. There was no statistically significant difference in the incidence of postoperative complications between the endoscopic and open surgery groups（P>0.05）. At 24 hours postoperatively, the visual analogue scale（VAS） pain scores were comparable between the two groups（P>0.05）. In contrast, cosmetic satisfaction scores were significantly higher in the endoscopic cohort compared to the open surgery group（P=0.003）.

Conclusion

Subclavicular approach endoscopic parathyroidectomy is an ideal treatment option compared to the median approach, effectively reducing serum PTH and calcium levels without increasing the risk of postoperative complications, while also satisfying patients' aesthetic needs. The surgery is safe and feasible, and has high clinical application value.