Application of endoscopic total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism in chronic renal failure

To investigate the clinical efficacy of endoscopic total parathyroidectomy with autotransplantation (ETPTX + AT) in the treatment of secondary hyperparathyroidism (SHPT) in chronic renal failure. A total of 433 patients who underwent ETPTX + AT in our hospital from March 2019 to March 2024 were enrolled. By comparing preoperative and postoperative serum calcium, serum phosphate, and serum parathyroid hormone (PTH) levels, intraoperative conditions, postoperative complications, and changes in biochemical indicators before and after surgery as well as during follow-up were observed. Postoperative PTH levels were < 100 pg/mL in 412 patients (95.2%). Postoperative PTH, serum calcium, and serum phosphate levels were significantly decreased compared with preoperative levels, with statistically significant differences ( p < 0.05). During the perioperative period, one patient (0.23%) died due to cardiac insufficiency, four patients (0.9%) experienced transient recurrent laryngeal nerve injury, 69 patients (15.9%) developed hypocalcemia (< 2.1 mmol/L) postoperatively, one patient (0.23%) required conversion to open surgery, seven patients (1.6%) had postoperative upper limb vascular access occlusion, and one patient (0.23%) developed a neck hematoma. Follow-up was completed in 388 patients (89.6%). No statistically significant differences were found in serum calcium levels between preoperative and postoperative values at 1 week, 3 months, and 12 months after surgery (all p > 0.05), while serum phosphate and parathyroid hormone levels were significantly lower than preoperative levels (all p < 0.001). ETPTX + AT is a highly effective treatment for SHPT, significantly reducing PTH, serum calcium, and serum phosphate levels. Clinical trial number Not applicable.