Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature

Abstract

Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.

Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves

“…Remote-access techniques, including robotic-assisted transaxillary surgery, have proven to be effective and safe for thyroid surgery in patients with specific selection and when performed by high-volume surgeons (9)(10)(11)(12)(13)(14)(15). The literature on remote access techniques for parathyroidectomy has consisted mostly of small case series (4,9,(16)(17)(18)(19). This includes the results of initial experience of the authors with the robotic-assisted transaxillary gasless approach to parathyroidectomy at our North American institution in 2014, in which we documented a series of nine patients with confirmed PHPT who underwent surgery between September 2010 and March 2011 (18).…”

The Main Surgical Principles and Techniques In the Management of Primary Hyperparathyroidism

“…[50] Daha sonraları bu teknikle parati-roidektomi ameliyatları da (TOEPVA) yapılmaya başladı ve transoral vestibüler robotik paratiroidektomi de gündeme girdi. [74][75][76] (Şekil 7) Dünyada TOETVA'nın giderek yaygınlaşmasına karşın TOEPVA uygulanan olgu sayısı halen sınırlıdır. Bu yöntem boyunda görünür yara izi bırakmamakla beraber lateral açık MİP'e göre daha geniş subplatismal alan ve doku diseksiyonu gerektirmektedir.…”

Scoping review of approaches used for remote‐access parathyroidectomy: A contemporary review of techniques, tools, pros and cons

“…In 2016, the American Thyroid Association Surgical Affairs Committee classified RAT into four approaches: (1) breast approach, (2) bilateral axillo‐breast approach, (3) axillary approach, and (4) facelift approach. Even within the past few years however, new remote‐access approaches have been verified and reported 3,8,9 . For example, the transoral approach is starting to be performed in the United States.…”

“…The use of transoral robotic parathyroidectomy has not yet become common. Only one article reported this robotic approach 9 . In that article, half of the cases were converted to OP.…”

“…Even within the past few years however, new remote-access approaches have been verified and reported. 3,8,9 For example, the transoral approach is starting to be performed in the United States. Moreover, RAP is as different from RAT; for example, the bilateral axillo-breast approach is not common in the field of RAP.…”