Preoperative localization studies for parathyroid adenomas are very essential to perform minimal invasive parathyroidectomy (MIP) with decreased operative time and potential complications. Although most of these studies based on radiological imaging, intraoperative assessment provides the most accurate anatomical description of the location of parathyroid adenomas. In this study, we aim to evaluate the surgical variations of locations of parathyroid adenomas in patients performed parathyroid surgery for primary hyperparathyroidism (PHPT).

Between January 2010 and December 2013, 243 patients (201 women/42 men) who underwent parathyroid surgery due to phPT were included. A total of 254 parathyroid adenomas were detected. Demographic features, preoperative work-up, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using t-test and chi-square. continuous data are expressed as mean ± standard deviation.

With regard to the most frequently observed, location of adenomas were as follows; right inferior (n = 89, 37.7%), left inferior (n = 78, 33%), right superior (n = 44, 18.6%), left superior (n = 25, 10.5%) and ectopic locations (n = 18). Ectopic adenomas were mostly located in the thymus (n = 9) and intrathyroidal tissue (n = 6) at a rate of 83%. Postoperative hypocalcemia (11%) was mostly seen in those with parathyroid adenoma located around the inferior lobes of the thyroid (86%) and undergoing bilateral neck exploration (75%).

The most of the parathyroid adenomas were found in orthotopic position and located around the lower pole of the thyroid gland. Ectopic adenomas were mostly located in thymus or intrathyroidal. Postoperative hypocalcemia was also higher in those with parathyroid adenoma located around the inferior lobe of the thyroid.

Yazici P, Mihmanli M, Bozdag E, Aygun N, Uludag M. Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look? World J Endoc Surg 2015;7(1):1-5.

Surgery for thyroid cancers often necessitates a neck dissection. This is usually a safe procedure, but can be associated with complications. Chyle leak is one such complication, fortunately rare. There is a dearth of literature with regard to the management of chyle leak in the neck. We present a single center experience in the management of chyle leak in the neck, to improve the understanding of its management.

A retrospective analysis of patients with thyroid cancer, managed between January 1st 2005 and December 31st 2011, in a single institution was performed. Among these, patients with chyle leak were identified. All pertinent data collected and results analyzed using STATA (v10).

Three hundred and seventy-three/eight hundred and twenty-one (45.4%) patients surgically managed for thyroid cancer underwent a neck dissection. Thoracic duct injury was recog- nized and managed intraoperatively in 20/373 (5.4%) patients. The leak was prevented in the majority (66.6%) of patients in whom a combination of methods were employed. 25/373 (6.7%) patients were diagnosed and managed for chyle leak postoperatively. Seven patients required re-exploration. This included patients with low output chyle leaks who may have settled in a week to 10 days with conservative management. A combination of techniques was successful in the majority (71.4%). The remaining patients were successfully managed conservatively.

We conclude that using a combination of methods to manage thoracic duct injury may be better than using a single modality alone. Early re-exploration was more economical and acceptable for a subset of our patients, as they come from long distances at personal cost.

Cherian a, Ramakant P, Paul MJ, Abraham DT. Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience. World J Endoc Surg 2015;7(1):6-9.

Maturi R, Makineni H, Marri SSK. A Unique Case of Osteitis Fibrosa Cystica with Postoperative Hungry Bone Syndrome and Hypocalcemic Cardiac Failure. World J Endoc Surg 2015;7(1):10-13.

A nonrecurrent course is an unusual anatomic variation of the recurrent laryngeal nerve. It is seen usually on the right side, and it is very rare on the left side. Nonrecurrent laryngeal nerve if present is mostly associated with vascular anomalies.

A 55-year-old female was referred to us with thyrotoxic symptoms for a period of 6 months. She was rendered euthyroid with antithyroid medications. After complete evaluation, she was posted for total thyroidectomy. Intraoperatively, right recurrent nerve could not be identified in usual position. On careful dissection, a nonrecurrent laryngeal nerve was identified. The recurrent laryngeal nerve on the left side showed normal course. The intraoperative and postoperative period were uneventful. Postoperative vocal cord status was normal.

This case was presented for its rarity and to stress the need for orderly meticulous surgical dissection.

Ravikumar K, Sadacharan D, Suresh Rv. Surgical Delight: Nonrecurrent Laryngeal Nerve. World J Endoc Surg 2015;7(1):14-16.

Player H, Babkowski R, Dong X. A Cautionary Case: Adrenal Insufficiency after Unilateral Adrenalectomy for Adrenocortical Carcinoma. World J Endoc Surg 2015;7(1):17-20.

Mishra P, Mayilvaganan S, Agarwal A. Statistical Methods in Endocrine Surgery Journal Club. World J Endoc Surg 2015;7(1):21-23.

Sadacharan D, Mahadevan S, Ravikumar K, Muthukumar S. Primary Pigmented Nodular Adrenocortical Disease: A Rare Cause of Cushing's Syndrome. World J Endoc Surg 2015;7(1):24-25.