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.
Minimal invasive surgery Robotic surgery Thoracoscopic surgery Parathyroid adenoma Parathyroidectomy
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