Mediastinal Parathyroidectomy with the da Vinci Robot

Abstract

<jats:p> Mediastinal parathyroid glands are often located in a position which is inaccessible through a cervical approach. Because of the significant morbidity of open surgery, the need for minimal invasive approaches is high. More recently, robotic systems have been introduced to refine the dissection and optimize the view in the mediastinal region. We present two cases. The first case is a 34-year-old woman who was diagnosed with primary hyperparathyroidism. Because a bilateral neck dissection disclosed no parathyroid adenoma, we performed a parathyroid sestamibi scan and computed tomographic scan of neck and mediastinum to look for aberrant parathyroid glands. Both showed a parathyroid adenoma in the mediastinum on the left side. The second case is a 66-year-old man. A sestamibi scan showed a parathyroid adenoma of 3 cm in the superior mediastinum which was confirmed by and computed tomographic scan. In both cases, we performed a parathyroidectomy with the da Vinci robotic system through a left-sided approach. Three thoracoports were inserted around the mammary gland for the robot and a fourth auxiliary port was positioned in between. Single-lung ventilation was installed, and the mediastinum was entered by opening the parietal pleura along the left phrenic nerve. The upper margin for dissection was the left brachiocephalic vein that was followed until the right pleura. All the tissue in front of the pericardium was dissected en bloc. The sinking test of the nodule and a preoperative frozen section analysis confirmed the diagnosis of parathyroid adenoma, which was also proven by rapid parathyroid hormone analysis. The resection of a parathyroid adenoma from the aortopulmonary window represents an ideal case for robotic surgery. </jats:p>

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

“…To date, published data on robotic-assisted mediastinal parathyroid extirpation are limited to case reports and small case series. [34][35][36][37][38][39][40][41] Data from these series demonstrate that resection of these mediastinal parathyroid glands is feasible and safe when using the robotic-assisted system. In addition, when navigating around areas such as the aortopulmonary window, use of the robotic-assisted system has been shown to be superior to videothoracoscopic surgery.…”

Robotic Parathyroid Surgery: Current Perspectives and Future Considerations

“…Ectopic parathyroid adenomas have been successfully resected with the da Vinci® surgical robot from a variety of anatomical locations including the mediastinum [22], pericardium [23], retropharyngeal space [24], and piriform sinus [25]. Thoracoscopic robotic approaches were used for the former two and transoral robotic surgery (TORS) for the latter two.…”

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

“…11 This subsequently has standardized the concept of MAS for the surgical management of PHPT (minimally invasive parathyroidectomy, MIP) with the multiple techniques that already exist or are evolving (focused, endoscopic, video assisted, radioguided 12 or roboticassisted [13][14][15][16] ). Additionally, operating through MAS has allowed PHPT surgery to be occasionally carried out under local anesthesia 17 and even be practiced as day-care surgery.…”