Comparing Outcomes in Video-Assisted and Open Parathyroidectomy for Patients With Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

Comparing Outcomes in Video-Assisted and Open Parathyroidectomy for Patients With Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

The treatment of primary hyperparathyroidism (PHPT) has evolved beyond traditional 4-gland exploration to more targeted and less invasive approaches. One such approach is the minimally invasive video-assisted parathyroidectomy (MIVAP). While this has been adopted by several institutions who reported promising results, there have been no assessment of the existing literature of its efficacy and safety. The aim of this study was to compare the outcomes of MIVAP and open surgery for PHPT. We performed a systematic review and meta-analysis of literature comparing outcomes of MIVAP vs. open surgery for PHPT. Forty studies were shortlisted, of which 14 were comparative. Two thousand thirty-five patients underwent MIVAP of mean age 58.6±7.8 years. Mean length of stay (LOS) was 1.83±1.3 days, pain score 1.84±0.69 and satisfaction with cosmesis 8.8±0.63. Bleeding risk was 0.4%, recurrent laryngeal nerve (RLN) injury risk was 1.3%, and no post-operative mortality was reported. Patients who underwent MIVAP had a significant shorter LOS compared to open surgery (mean difference, −0.27; 95% confidence interval, −0.45, −0.10; P=0.002), but had no difference in pain, cosmesis, failure to cure, bleeding, and RLN injury risks. MIVAP is safe and efficacious in treating PHPT, and may be associated with shorter LOS.