Robotic surgery for primary hyperparathyroidism

Abstract

This initial study shows that robotic TAC and TTM parathyroidectomy are feasible in selected PHP patients with preoperatively well-localized disease. Although the TAC approach offers a potential cosmetic benefit in patients with a history of keloid or hypertrophic scar formation, a more generalized use cannot be recommended based on current evidence. The robotic TTM approach presents a minimally invasive alternative to resections previously performed through thoracotomy and sternotomy.

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

“…37 Case patients were followed for 41 months, at which time all 5 patients were free of symptoms and had calcium levels within the normal range, thus demonstrating that robotic-assisted mediastinal parathyroidectomy is effective. 37 A larger series of 6 patients who underwent robotic-assisted mediastinal parathyroidectomy was published by Karagkounis et al 42 Median operating time was 168 minutes, and nearly all study patients (all except 1) had an effective operation, as evidenced by a decreased level of intraoperative parathyroid hormone of more than 50% 10 minutes following excision. 42 The mean pain score was 7.7 out of 10 on postoperative day 1 and 1.5 out of 10 on postoperative day 10, and the average LOS was 2.2 days.…”

“…37 A larger series of 6 patients who underwent robotic-assisted mediastinal parathyroidectomy was published by Karagkounis et al 42 Median operating time was 168 minutes, and nearly all study patients (all except 1) had an effective operation, as evidenced by a decreased level of intraoperative parathyroid hormone of more than 50% 10 minutes following excision. 42 The mean pain score was 7.7 out of 10 on postoperative day 1 and 1.5 out of 10 on postoperative day 10, and the average LOS was 2.2 days. 42 A complication occurred in 1 study patient (pericardial and bilateral pleural effusions requiring drainage).…”

Robotic Transaxillary Parathyroid Surgery

“…After proper positioning, Noureldine et al [4] reported taking blood to measured baseline PTH levels. In some reports, the exact location of the lesion was visualized with USG before the initial incision [10,13].…”

“…Common complications in open parathyroid surgery include hematoma, airway obstruction, recurrent laryngeal nerve injury, tracheal injury, vascular injury, and postoperative hypocalcemia [12][13][14]. These complications can also occur in RTAPS.…”

Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism

“…At 6-month follow-up, the overall cosmetic outcome was subjectively considered to be good with the incision scar located in the axilla area. Lastly, Karagkounis et al retrospectively evaluated eight patients who underwent transaxillary robotic parathyroidectomy for a preoperatively localized cervical parathyroid adenoma (35). All patients were cured of their disease with 6-month follow-up.…”