Outpatient video-assisted thoracoscopic surgery (VATS) for ectopic mediastinal parathyroid adenoma: a case report and review of the literature

Up to 20% of abnormal parathyroid glands causing primary or secondary hyperparathyroidism are located ectopically. Of these, approximately 1%-2% reside in the mediastinum and may not always be resectable through a traditional cervical approach. Recently, video-assisted thoracoscopic surgery (VATS) has arisen as a minimally invasive method for resecting mediastinal parathyroid glands and avoiding the complications and higher morbidity of a sternotomy. In this paper, we present a case of a patient with asymptomatic hyperparathyroidism and an ectopic parathyroid on sestamibi imaging in the mediastinum. Initially, the patient underwent a bilateral cervical exploration, left upper parathyroidectomy, and partial thymectomy; however, postoperatively, he continued to have persistently elevated serum calcium and parathyroid hormone levels. Ultimately, management consisted of parathyroidectomy through a VATS approach, along with intraoperative parathyroid assay monitoring and frozen-section pathologic analysis. The patient was successfully discharged to home several hours after surgery. To our knowledge, this is the first reported case of mediastinal ectopic parathyroid adenoma treated with outpatient VATS.