Transoral endoscopic parathyroidectomy vestibular approach: our experience from a single center in Kuwait.

Objective and background: We present our experience with the first five parathyroidectomies performed in Kuwait using the transoral endoscopic vestibular approach. Methods: Retrospective data collection of trans-oral endoscopic vestibular parathyroidectomies was performed at a single institution in Kuwait. Patient eligibility was determined by previously published exclusion criteria. Information on patient demographics, perioperative management, and complications was collected and reviewed. Outcomes: In our case series, we present five patients who underwent transoral endoscopic parathyroidectomy via the vestibular approach. All included patients had a biochemical diagnosis of primary hyperparathyroidism and two concordant localizing studies demonstrated a single parathyroid adenoma. All patients were above 18 years of age, had no previous neck surgery, and were not on anticoagulants. No intraoperative complications were reported, and the mean operative time was 180 minutes. Postoperatively, four patients were discharged on the same day while one patient was discharged on postoperative day 2. During follow-up, no complications were reported, and the patients reported satisfactory cosmetic results. Finally, parathyroid adenoma was confirmed in the final histopathology report in all five cases. Conclusion: The transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) is a viable, safe, and cosmetically advantageous option for parathyroidectomy in select patients. Careful patient selection is crucial, with criteria including a single adenoma identified on preoperative imaging, and no history of neck surgery or anticoagulant use. Further research is needed to clarify TOEPVA's role in the surgical management of primary hyperparathyroidism and to explore its long-term outcomes in a larger, diverse patient population.