Minimally invasive video‑assisted parathyroidectomy

5.1 Unilateral vocal cord paresis was reported in 3% (2/68) of patients treated by minimally invasive video‑assisted parathyroidectomy (MIVAP) and 1% (1/75) of patients treated by open minimally invasive parathyroidectomy (OMIP) in a randomised controlled trial (RCT) of 143 patients (p value not reported). This resolved within 3 months in the 2 patients treated by MIVAP but was still present 6 months after surgery in the patient treated by OMIP. Laryngeal nerve palsy 6 months after surgery was reported in 1 patient treated by MIVAP and no patients treated by conventional parathyroidectomy in an RCT of 38 patients. Transient recurrent laryngeal nerve palsy was reported in 1% (1/100) and 3% (2/68) of patients treated by MIVAP or OMIP respectively in a non‑randomised comparative study of 168 patients (p=not significant). Permanent recurrent laryngeal nerve palsy was reported in 1% (1/107, and 4/652) of patients in 2 case series of 107 and 652 patients respectively.

5.2 Postoperative bleeding that needed reoperation was reported in 1 patient in the case series of 652 patients (caused by a displaced clip on a middle thyroid vein).

5.3 Symptomatic transient hypocalcaemia after the procedure was reported in 3% (1/30) and 7% (2/30) of patients treated by MIVAP and OMIP respectively in an RCT of 60 patients, and in 5% (1/20) and 17% (3/18) of patients treated by MIVAP and conventional parathyroidectomy respectively in the RCT of 38 patients (p values not reported). Symptomatic hypocalcaemia was reported in 13% (14/107) of patients in the case series of 107 patients (2 patients needed vitamin D supplementation).

5.4 The specialist advisers listed additional theoretical adverse events as infection, injury to local neuro-vascular structures or trachea/oesophagus.