Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

“…This approach was required to identify which of the parathyroid glands was clinically abnormal and to ensure that additional abnormal glands were not overlooked. BNE with four‐gland dissection, however, required a large cosmetically less favorable incision, exposed both recurrent laryngeal nerves (RLNs) to potential iatrogenic injury, and subjected the patient to the risk of permanent hypoparathyroidism …”

Robotic transaxillary parathyroidectomy

“…Endoscopic surgery has been adopted in most institutions for parathyroid gland removal, and several studies have demonstrated reduced postoperative pain and improved cosmetic outcome as compared to traditional open approach (1). Application of robotic technology for parathyroid removal has been less extensively studied and its use has not been widely adopted.…”

“…Application of robotic technology for parathyroid removal has been less extensively studied and its use has not been widely adopted. Previous studies have documented the safety of the procedure with the advantages of greater image magnification, gasless technique, and a hidden axillary incision (1)(2)(3)(4). Herein we present our technique of robotic transaxillary parathyroidectomy at an academic institution.…”

Robotic Transaxillary Parathyroid Surgery

“…In the 1970s, parathyroid resection was done through a large incision made in the neck that allowed for full exploration and exposure of all four parathyroid glands. This method had a success rate of 97% there were complications in 1-2% of cases [1]. Typically, parathyroid adenomas are found only in a single gland, and targeted therapy can be performed that removes only the pathological gland.…”

“…Typically, parathyroid adenomas are found only in a single gland, and targeted therapy can be performed that removes only the pathological gland. The 1980s saw the introduction of first one-sided two-gland, and then single-gland surgeries, made possible by the development of more advanced preoperative imaging methods and the introduction of intraoperative parathyroid hormone monitoring [1,2].…”