Minimally invasive techniques for giant parathyroid tumours; An oxymoron?

Aim-Background On rare occasions, a parathyroid tumour weighing more than 3.5 grams is removed; such a tumour is referred to as a “giant” tumour. We report 47 cases of giant parathyroid tumours, the second largest published series so far. Patients-Methods We retrospectively reviewed all prospectively collected data of operations performed for primary hyperparathyroidism over a period of 16 years. The duration of the operation, length of hospital stay, conversions and complications rates were recorded prospectively. Results Giant parathyroid tumours were removed in 47 out of the 457 cases (10.28%). The mean weight of the parathyroid tumour in the group receiving minimally invasive surgery was 8.9 grams (3.5–20 grams) with a mean size of 5.4 cm (1.7–7 cm). Twenty-seven patients had a minimally invasive parathyroidectomy and 20 underwent a classical procedure. There were no complications or recurrences. Mean hospital stay was approximately 20 hours (19–23 hours), and mean follow-up was 33 months (3–70 months). Conclusion These results illustrate that minimally invasive techniques are a valuable option in selected patients with giant parathyroid tumours. Surgical expertise in the endocrine field cannot be overemphasized.