1.1 There is limited evidence to support the efficacy of thoracoscopic excision of mediastinal parathyroid tumours. The evidence on safety is also very limited in quantity, and in view of potential complications of the procedure it should only be used with special arrangements for clinical governance, consent, audit and research.
1.2 Clinicians wishing to undertake thoracoscopic excision of mediastinal parathyroid tumours should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the potential complications of the procedure and provide them with clear written information. In addition, use of the Institute's information for patients ('Understanding NICE guidance') is recommended.
Audit and review clinical outcomes of all patients having thoracoscopic excision of mediastinal parathyroid tumours (see section 3.1). It is recommended that clinicians undertaking this procedure should collaborate in the collection and review of data.
1.3 Patient selection for thoracoscopic excision of mediastinal parathyroid tumours should be carried out in specialist units and in the context of a multidisciplinary team that includes a thoracic surgeon experienced in thoracoscopic techniques. Preoperative imaging should always be undertaken to confirm the location of the mediastinal tumour.