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Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP)


This technique is being used with extraordinary results in several specialized medical centers in Europe, the USA and other institutions around the world. The technique has been established by P. Miccoli, Professor of Endocrine Surgery, Pisa University.

The preoperative localization of the glands is a prerequisite for patients who are candidates for MIVAP. The ultrasound and the TC- Sestamibi-scan constitute the standard techniques, while in some rare occasions additional methods are required for the localization of the pathological parathyroid glands.



  • Solitary adenoma
  • Screening confirmation
  • Absence of indications for multiple endocrine neoplasia (MEN) or familiar hyperparathyroidism
  • Absence of a large goiter
  • Absence of malignancy
  • Absence of any history of neck irradiation



The operation is performed through a small incision above the suprasternal notch. Through this incision along with the aid of special surgical tools, the abnormal parathyroid gland is accessed. Operating field visualisation is enabled with the use of a high definition micro camera. The use of the neurostimulator for the identification and preservation of the recurrent laryngeal nerve is essential.


The operation is completed with the removal of the pathological parathyroid gland(s) and the intraoperative confirmation of the decrease of parathormone levels(quickPTH) in a specific time. In this manner we confirm, by means of laboratory, the biochemical healing of the patient.



The most important advantages of the technique are:

  • Postoperative pain is less, which results in reduced  demand and therefore reduced use of analgesics. 
  • With regard to the aesthetic result, patients who have been operated on with the MIVAP technique are mostly satisfied.


The Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) technique has excellent results. It can be performed only under certain circumstances and with specific indications. Only a certified endocrine surgeon is capable of selecting patients who may be operated on with the MIVAP technique.