Thoracoscopy is the preferred approach to intrathoracic hyperfunctioning parathyroid glands. However, data on its feasibility and safety are limited due to the rarity of this condition.

A retrospective cohort included 24 patients who underwent thoracoscopic parathyroidectomy from 2002 to 2023. 15 patients underwent their initial operation for primary hyperparathyroidism (HPT), seven patients had persistent primary HPT after cervical operations, and two had recurrent secondary HPT. MIBI-scintigraphy suspected the location of the parathyroid in 15 cases. In all cases, the intrathoracic localization was confirmed by cross-sectional imaging. The operations were performed in the supine (n=12) or lateral (n=13) position using three trocar sites.

Median operating time was 60 minutes (range: 20-320 minutes). The cure rate was 100%. One patient required a re-thoracoscopy and one cervical exploration. In four cases, the positions of the gland were truly ectopic: in the aortopulmonary window (n=1), on the surface of the pulmonary trunk (n=2), or on the surface of the pericardium (n=1). No conversion to open surgery was needed. One patient developed a postoperative chylothorax and one temporary phrenic nerve palsy. Multivariate logistic regression showed that the small size of a lesion and its position in the anterior mediastinum are negatively associated (p = 0.039 and 0.027 respectively) with the duration of surgery.

Thoracoscopic parathyroidectomy is feasible and safe. The short hospital stay and low complication rate are the main advantages compared to the historical series of conventional operations.