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Robot-Assisted Endoscopic Mediastinal Parathyroidectomy

  • Özer Makay
  • Murat Özdemir
Chapter

Abstract

Case Report: A 45-year-old man admitted to an outside hospital with a history of nephrolithiasis, diffuse joint pain, and problems with walking, lasting for a year. The patient had normal findings on physical examination. Blood tests revealed elevated serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and a decreased phosphate level. Ultrasound of the neck showed no evidence of parathyroid adenoma. Subsequently, a computed tomography scan of the thorax showed a hypervascular solitary nodule of 2 cm in the anterior mediastinum, at the level of the anterior aspect of the ascending aorta. 99mTc methoxyisobutylisonitrile (MIBI) scintigraphy confirmed the presence of an adenoma.

Surgery was performed thoracoscopically with the da Vinci Si robotic system. Four ports were used for the operation, three of them for the robotics arms and one for assistance. Post-excision PTH level was used for intraoperative confirmation of success. The total operative time was 119 min. Intraoperative blood loss was minimal, and no complications occurred during the operation. The patient was discharged without any complications on the fourth postoperative day.

The robotic technique provides excellent visualization with a three-dimensional view, better color resolution, better contrast, precision, and enhanced skills in order to ensure an effective, safe, and accurate operation. The robotic approach is our preferred method for mediastinal located parathyroid glands. Besides, accurate localization of the ectopic parathyroid gland(s) due to preoperative screening is an important aspect of the robotic approach.

Keywords

Minimal invasive surgery Robotic surgery Thoracoscopic surgery Parathyroid adenoma Parathyroidectomy 

References

  1. 1.
    Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992;215:300–17.CrossRefGoogle Scholar
  2. 2.
    Freeman JB, Sherman BM, Mason EE. Transcervical thymectomy: an integral part of neck exploration for hyperparathyroidism. Arch Surg. 1976;111:359–64.CrossRefGoogle Scholar
  3. 3.
    Alesina PF, Moka D, Mahlstedt J, Walz MK. Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg. 2008;32:224–31.CrossRefGoogle Scholar
  4. 4.
    Russell CF, Edis AJ, Scholz DA, Sheedy PF, van Heerden JA. Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg. 1981;193:805–9.CrossRefGoogle Scholar
  5. 5.
    Iihara M, Suzuki R, Kawamata A, Horiuchi K, Okamoto T. Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J Surg. 2012;36:1327–34.CrossRefGoogle Scholar
  6. 6.
    Rea F, Schiavon M, Di Chiara F, Marulli G. Single-institution experience on robot-assisted thoracoscopic operations for mediastinal diseases. Innovations (Phila). 2011;6:316–22.CrossRefGoogle Scholar
  7. 7.
    Balduyck B, Hendriks JM, Lauwers P, Mercelis R, Ten Broecke P, Van Schil P. Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection. Eur J Cardiothorac Surg. 2011;39:543–8.CrossRefGoogle Scholar
  8. 8.
    Ismail M, Maza S, Swierzy M, Tsilimparis N, Rogalla P, Sandrock D, et al. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg. 2010;97:337–43.CrossRefGoogle Scholar
  9. 9.
    Chan AP, Wan IY, Wong RH, Hsin MK, Underwood MJ. Robot-assisted excision of ectopic mediastinal parathyroid adenoma. Asian Cardiovasc Thorac Ann. 2010;18:65–7.CrossRefGoogle Scholar
  10. 10.
    Van Dessel E, Hendriks JM, Lauwers P, Ysebaert D, Ruyssers N Jr, Van Schil PE. Mediastinal parathyroidectomy with the da Vinci robot. Innovations (Phila). 2011;6(4):262.CrossRefGoogle Scholar
  11. 11.
    Karagkounis G, Uzun DD, Mason DP, Murthy SC, Berber E. Robotic surgery for primary hyperparathyroidism. Surg Endosc. 2014;28:2702–7.CrossRefGoogle Scholar
  12. 12.
    Brunaud L, Ayav A, Bresler L, Schjött B. Da Vinci robot-assisted thoracoscopy for primary hyperparathyroidism: a new application in endocrine surgery. Thoracoscopie robotique pour hyperparathyroidie primaire: nouvelle application en chirurgie endocrinienne. J Chir (Paris). 2008;145:165–7.CrossRefGoogle Scholar
  13. 13.
    Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007;188:1706–15.CrossRefGoogle Scholar
  14. 14.
    Timmerman GL, Allard B, Lovrien F, Hickey D. Hyperparathyroidism: robotic-assisted thoracoscopic resection of a supernumary anterior mediastinal parathyroid tumor. J Laparoendosc Adv Surg Tech A. 2008;18:76–9.CrossRefGoogle Scholar
  15. 15.
    Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E. Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2011;21:24–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Özer Makay
    • 1
  • Murat Özdemir
    • 1
  1. 1.Division of Endocrine SurgeryEge UniversityİzmirTurkey

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