Application of the Technique for In-Situ Preservation of Parathyroid Glands in Endoscopic Thyroidectomy via the Chest-Breast Approach

Introduction:

Transient and permanent hyperparathyroidism are very common in thyroid surgery. Exploring the technique for in-situ preservation of parathyroid glands in endoscopic thyroidectomy via the chest-breast approach.

Materials and Methods:

The inferior parathyroid gland (IPTG) is the most variable in position and has a complex blood supply, making it prone to iatrogenic injury during thyroid surgery. The thyrothymic ligament (TTL), a connective tissue linking the thymic lingula to the thyroid, serves as a critical anatomical landmark for locating and protecting the IPTG. IPTG Preservation: The thymus was identified in the suprasternal notch and dissected from its lower to upper pole along its lateral margin. The TTL was separated until its insertion, and the IPTG was identified at the TTL’s end. The connective tissue between the TTL and the thyroid was divided, and the blood supply to the IPTG was preserved. The IPTG was preserved in situ. Superior parathyroid gland (SPTG) Preservation: It was identified by dissecting along the posterior capsule of the thyroid upper pole. The blood supply and surrounding adipose tissue of the SPTG were preserved. The SPTG was preserved in situ.

Results:

The fine dissection can preserve the IPTG and the SPTG in situ during the operation of thyroid cancer, reduce the intraoperative blood loss, postoperative drainage flow, and accidental resection of the parathyroid gland, and protect the parathyroid function to the greatest extent.

Conclusions:

Endoscopic in-situ preservation of the SPTGs and IPTGs along with their blood supply can reduce the incidence of both transient and permanent postoperative hypoparathyroidism, thereby improving the patient’s quality of life after surgery.

For Video Submission to VE. Nan Xu, Shikuo Rong, author and corresponding author of the video titled “Application of the technique for in-situ preservation of parathyroid glands in endoscopic thyroidectomy via the chest-breast approach” (Submission ID: VE-2025-0016), hereby declare the following commercial associations and potential conflicts of interest related to this work during the past 2 years (2023–2025).

The video received financial support from: National Key Clinical Specialty Construction Project Z155080000004, National Natural Science Foundation of China 82504171.

Verification.

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Patient consent: Patient consent was obtained for video recording and publication.

Runtime of video: 9 min 34 secs.