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Fu K, Zhu XY, Jia XY, Feng KP, Cui Y, Zhao J, Li C. Thoracoscopic resection of paraesophageal ectopic mediastinal parathyroid adenoma in the superior posterior mediastinum: a case report. J Cardiothorac Surg 2024; 19:228. [PMID: 38627802 PMCID: PMC11020341 DOI: 10.1186/s13019-024-02729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The ectopic superior parathyroid in the tracheoesophageal groove and paraesophageal region is rare. Hyperparathyroidism results when these glands become hyperfunctioning. That may necessitate surgical intervention in the form of parathyroidectomy, which requires a transsternal or transthoracic approach due to a deeply seated mediastinal parathyroid gland. Minimally invasive strategies have emerged recently as an alternative approach with less morbidity. CASE PRESENTATION We present a case of the paraesophageal ectopic parathyroid gland in the superior posterior mediastinum, which was successfully treated with thoracoscopic resection. CONCLUSION The current imaging tools improve the thoracoscopic management of mediastinal parathyroid glands. Video-assisted thoracoscopic surgery (VATS) can provide access and exposure to ectopic parathyroid adenoma with low morbidity and financial burden.
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Affiliation(s)
- Kai Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Xin-Yu Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Xin-Yu Jia
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Kun-Peng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yuan Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Steinkraus KC, Wittau M, Kornmann M. Robotic-assisted thoracoscopy in the management of mediastinal ectopic parathyroid adenoma: a case report. J Surg Case Rep 2024; 2024:rjae044. [PMID: 38370589 PMCID: PMC10873174 DOI: 10.1093/jscr/rjae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Mediastinal ectopic parathyroid adenomas, a rare cause of primary hyperparathyroidism, has evolved significantly with the advent of robotic-assisted surgery. Traditional surgical approaches, while effective, may be associated with considerable morbidity and extended recovery periods. This study aims to evaluate the effectiveness, precision, and postoperative outcomes of robotic thoracoscopy with parathyroidectomy in the management of mediastinal ectopic parathyroid adenomas. A case of a 70-year-old man with a history of primary hyperparathyroidism underwent a successful left robotic thoracoscopy with parathyroidectomy in an ectopic mediastinal parathyroid adenoma. The robotic approach demonstrated advantages such as enhanced precision and minimal invasiveness. However, the learning curve and cost implications of this technology were identified as considerations. Robotic thoracoscopy with parathyroidectomy underscores the potential of robotic surgery in revolutionizing the management of mediastinal ectopic parathyroid adenomas, offering promising precision, emphasizing the need for ongoing research, and evaluation to optimize this innovative surgical method.
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Affiliation(s)
- Kira C Steinkraus
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Matthias Wittau
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Anemoulis M, Kachtsidis V, Geropoulos G, Panagiotopoulos N. Robot-Assisted Thoracoscopic Resection of Ectopic Parathyroid Tissue in Mediastinum: A Scoping Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:17-22. [PMID: 38344802 DOI: 10.1177/15569845231225668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Ectopic parathyroid tissue in the mediastinum represents a rare and potentially serious clinical entity with challenging diagnostic and surgical management. The main surgical approach for this issue is open thoracotomy, which is a safe technique but carries risks and complications associated with such as extensive surgery. The purpose of this study is to demonstrate robotic thoracic surgery as an alternative and potentially advantageous method to treat patients with ectopic parathyroid adenomas compared with open and video-assisted thoracoscopic surgery approaches. A total of 13 reports in the literature were identified that provided details in terms of complications, surgical approach, and results of minimally invasive surgical resection of mediastinal ectopic parathyroid tissue.
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Affiliation(s)
- Marios Anemoulis
- School of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Georgios Geropoulos
- School of Medicine, Aristotle University of Thessaloniki, Greece
- Department of General Surgery, Victoria Hospital, NHS Fife, Kirkcaldy, UK
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Lee JS, Lee JS, Jeong H, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS. Robotic parathyroidectomy is a feasible technique for primary hyperparathyroidism. Langenbecks Arch Surg 2023; 409:10. [PMID: 38103090 PMCID: PMC10725346 DOI: 10.1007/s00423-023-03182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center. METHODS We assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time. RESULTS Of the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15-65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively. CONCLUSIONS Robotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.
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Affiliation(s)
- Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojung Jeong
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea.
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
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Rückert JC, Huang L. [Robot-assisted Mediastinal Surgery]. Zentralbl Chir 2023; 148:S17-S25. [PMID: 36195108 DOI: 10.1055/a-1921-1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Because of the many important anatomical structures located closely together at very small distances, mediastinal surgery has been traditionally demanding and challenging within thoracic surgery. With their great variability, mediastinal masses in the anterior, middle or posterior mediastinal compartment result in surgical indications with different principle focuses. The technical opportunities of robotic assistance can thereby most effectively support the requirement of precision for all oncological aspects. Anterior mediastinal operations are most often performed, thymectomy being the most common operation. The radicality of thymectomy is of special importance. The worldwide tremendous development of robot-assisted mediastinal surgery confirms its initial and continuous role as a pacemaker for minimally invasive thoracic surgery.
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Affiliation(s)
| | - Luyu Huang
- Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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6
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Robotic Mediastinal Surgery. Thorac Surg Clin 2023; 33:89-97. [DOI: 10.1016/j.thorsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Makey IA, Geldmaker LE, Casler JD, El-Sayed Ahmed MM, Jacob S, Thomas M. Localization and surgical approach to mediastinal parathyroid glands. J Cardiothorac Surg 2022; 17:299. [PMID: 36476282 PMCID: PMC9730602 DOI: 10.1186/s13019-022-02052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hyperactive parathyroid glands (PTGs) are in the mediastinum 4.3% of the time. Historically, localization and resection of these glands can be challenging. METHODS We searched all operative notes involving a thoracic surgeon and a preoperative diagnosis of hyperparathyroidism from 2001 to 2019. RESULTS Eighty-five cases were reviewed, of which 63 were included. Only 14 patients (22%) had de novo hyperparathyroid operations. Seventeen patients (27%) had single-photon emission computed tomography with computed tomography fusion (SPECT-CT) as the only preoperative localization test (excluding chest radiography and ultrasound), and all were resected successfully. The initial surgical approach was transcervical for 16 (27%) patients, however only 7 remained transcervical. 4 (6%) patients had an exploration in which the target lesion was resected but it was not parathyroid tissue. CONCLUSION Most patients presenting with mediastinal PTG have had prior HPT surgery. The trend toward more focused HPT surgery may mean more de novo mediastinal PTG resections. An unambiguous functional and anatomic localization test, such as a spect-ct scan, is the best predictor of a successful resection. Ambiguous or discordant scans should be approached cautiously, and additional confirmatory tests are recommended. For suspected PTG located in the thymus, the thoracic surgeon should choose the most familiar approach to achieve complete thymectomy.
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Affiliation(s)
- Ian A. Makey
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Laura E. Geldmaker
- grid.417467.70000 0004 0443 9942Graduate Research Education Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL USA
| | - John D. Casler
- grid.417467.70000 0004 0443 9942Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Jacksonville, FL USA
| | - Magdy M. El-Sayed Ahmed
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Samuel Jacob
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
| | - Mathew Thomas
- grid.417467.70000 0004 0443 9942Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 USA
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8
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Ngo L, Wang C, Greene AC, Tsai AY, Kulaylat AN, Saunders BD. Mediastinal parathyroidectomy by VATS for persistent, sporadic primary hyperparathyroidism in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Rückert JC, Elsner A, Andreas MN. [Mediastinal Tumors]. Zentralbl Chir 2022; 147:99-120. [PMID: 35235970 DOI: 10.1055/a-1674-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.
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Affiliation(s)
- Jens-Carsten Rückert
- Chirurgische Klinik Campus Charité Mitte, Charité Universitätsmedizin, Berlin, Deutschland
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10
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Ramonell KM, Rentas C, Buczek E, Porterfield J, Lindeman B, Chen H, Fazendin J, Wei B. Mediastinal parathyroidectomy: Utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases. Am J Surg 2021; 223:681-685. [PMID: 34481661 DOI: 10.1016/j.amjsurg.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The majority of ectopic mediastinal parathyroid adenomas are accessible transcervically and those not amenable to this approach pose a significant clinical and technical challenge. METHODS Retrospective review of transthoracic robot-assisted mediastinal parathyroidectomy (TTRMP) for primary hyperparathyroidism between 2012 and 2019 at a single institution. RESULTS 16 patients underwent TTRMP, 63% were female with a mean age of 64 ± 2.0 years. Nine of 16 had prior parathyroidectomy; 80% had persistent disease and a mean 2.8-year delay from index operation until TTRMP. Locations included: intrathymic (8), AP window (4), carina (3), and retroesophageal (1). Two patients underwent parathyroid reimplantation. Mean post-operative calcium and PTH were 9.2 ± 0.2 mg/dL and 20.2 ± 5.6 pg/mL, respectively. Complications included: temporary hypocalcemia (4), permanent hypocalcemia (1), DVT (1), hoarseness (1), and subcostal neuralgia (1). CONCLUSION In experienced hands, TTRMP is a safe and effective approach to mediastinal parathyroids not accessible transcervically. A multidisciplinary approach should be used in reoperative cases.
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Affiliation(s)
- Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, 1808 7th Ave South, BDB Suite 511, Birmingham, AL, 35233, USA.
| | - Courtney Rentas
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Erin Buczek
- University of Alabama at Birmingham, Department of Otolaryngology - Head and Neck Surgery, USA
| | - John Porterfield
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, USA
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Herbert Chen
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Jessica Fazendin
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, USA
| | - Benjamin Wei
- University of Alabama at Birmingham, Department of Surgery, Division of Cardiothoracic Surgery, USA
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Kandil E, Hadedeya D, Shalaby M, Toraih E, Aparício D, Garstka M, Munshi R, Elnahla A, Russell JO, Aidan P. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg 2021; 10:953-960. [PMID: 33842239 DOI: 10.21037/gs-20-761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background There have been few reports of robotic-assisted transaxillary parathyroidectomy in the literature. We aim to report our experience with robotic-assisted transaxillary parathyroidectomy for primary hyperparathyroidism (PHPT) in the Western population. Methods A retrospective study was performed from July 2010 through July 2019 at two institutions, one in the United States and one in France. Demographic characteristics and perioperative data were collected for all patients undergoing robotic-assisted transaxillary parathyroidectomy by a single surgeon at each institution. A linear regression model was developed to describe the learning curve for this procedure at each institution. Results One-hundred and two patients with PHPT were included with a median age of 55.6±12.4 years and median body mass index (BMI) of 25.5±6.1 kg/m2. The majority of patients were female (80.4%). Median total operative time was 116±53 minutes. Minor complications were reported in 2 patients (1.96%), and one case was converted to a trans-cervical approach (TCA) for four-gland exploration. Median patient follow-up time was 6.5±12.2 months, and disease recurrence was reported in one patient. Calculated learning curves showed that one surgeon achieved proficiency by the eighth case, and the other achieved proficiency by the fourteenth case. Conclusions This is the largest reported experience of robotic-assisted transaxillary parathyroidectomy for PHPT in the Asian and Western population. Analysis of the procedural learning curve demonstrates that proficiency in this technique was achieved after performance of less than 15 surgeries. This procedure is safe and feasible in the hands of experienced surgeons for select patients with localized disease.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deena Hadedeya
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Genetic Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - David Aparício
- Department of Otorhinolaryngology and Head and Neck Surgery, American Hospital of Paris, Paris, France
| | - Meghan Garstka
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ahmed Elnahla
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick Aidan
- Department of Otorhinolaryngology and Head and Neck Surgery, American Hospital of Paris, Paris, France
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How to do depends on where it settles: Mediastinal parathyroid adenomas. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:340-346. [PMID: 32551165 DOI: 10.5606/tgkdc.dergisi.2020.18764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/04/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate demographic characteristics, preoperative adenoma localization, surgical techniques selected according to the size and localization of adenoma, and clinical results of patients undergoing mediastinal parathyroid adenoma excision. Methods Medical records of a total of 11 patients (4 males, 7 females; mean age 52.6 years; range, 25 to 65 years) who underwent excision of mediastinal parathyroid adenoma in our clinic between January 2011 and June 2019 were retrospectively reviewed. Data including demographic characteristics, complaints, preoperative serum calcium, phosphorus, and parathyroid hormone levels, preoperative imaging methods, surgical method, localization and size of adenoma, length of hospital stay, and duration and amount of drainage were recorded. Results Adenoma was localized in anterior mediastinum in seven patients and in the middle mediastinum in four patients. The mean diameter calculated by taking into account the longest diameter of parathyroid adenoma was 21.1 mm. The mean drainage duration was 3.5 days in two patients undergoing median sternotomy, five days in one patient undergoing thoracotomy, 1.2 days in three patients undergoing video-assisted thoracoscopic surgery, and 0.6 days in five patients undergoing robotic surgery. Conclusion Minimally invasive approaches such as videoassisted thoracoscopic surgery and robotic-assisted surgery are safe and effective approaches for excision of mediastinal parathyroid adenoma.
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Scott BB, Maxfield MW, Hamaguchi R, Wilson JL, Kent MS, Gangadharan SP. Robot-Assisted Thoracoscopic Mediastinal Parathyroidectomy: A Single Surgeon Case Series. J Laparoendosc Adv Surg Tech A 2019; 29:1561-1564. [DOI: 10.1089/lap.2019.0266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Benjamin B. Scott
- Department of Surgery and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mark W. Maxfield
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer L. Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael S. Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sidhu P. Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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JIMÉNEZ-LÓPEZ MF, GÓMEZ-HERNÁNDEZ MT. Papel de la Cirugía Torácica en la cirugía de paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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15
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Nagano H, Suda T, Ishizawa H, Negi T, Kawai H, Kawakami T, Tochii D, Tochii S, Hoshikawa Y. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: subxiphoid and lateral thoracic approach. J Thorac Dis 2019; 11:2932-2938. [PMID: 31463122 DOI: 10.21037/jtd.2019.07.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to investigate the initial results of an endoscopic surgical approach for the treatment of intramediastinal ectopic parathyroid adenoma and to evaluate the effectiveness of a single-incision resection using the subxiphoid approach. Methods Five cases of patients (1.89%) were diagnosed with ectopic mediastinal parathyroid tumor and underwent resection from 2008 to 2017 in Fujita Health University Hospital. They were retrospectively analyzed. Results Four patients underwent single-port mediastinal tumor resection using the subxiphoid approach and 1 patient underwent multi-port mediastinal tumor resection using the lateral thoracic approach. The operation time was 134±83.52 min, and the amount of blood loss was 81.8±173.41 mL. The rate of conversion to thoracotomy was 0%, and no intraoperative or postoperative complications were observed. The amount of postoperative oral analgesics was 112.83±209.12 tablets, and their administration period was 561.6±1,229.5 days. The length of hospital stay was 4±2.35 days, and the duration of chest tube drainage was 1.33±1.95 days. The patient who underwent multi-port mediastinal tumor resection using the lateral thoracic approach reported postoperative pain. Serum calcium levels decreased from 10.56±1.52 mg/dL preoperatively to 8.96±0.5 mg/dL postoperatively, and serum phosphorous levels increased from 2.84±0.42 mg/dL preoperatively to 3.6±0.51 mg/dL postoperatively. Intact-PTH hormone levels decreased from 221±169.84 pg/dL preoperatively to 70.2±44.28 pg/dL postoperatively. No recurrence of hyperparathyroidism has been observed in any patient. Conclusions The single-incision mediastinal tumor resection via the subxiphoid approach, without going through the intercostal space, is considered as a useful endoscopic surgical approach for the treatment of mediastinal ectopic parathyroid adenomas due to the limited occurrence of post-thoracotomy pain syndrome and the superior esthetic outcomes associated with the procedure as compared to thoracotomy and median sternotomy.
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Affiliation(s)
- Hiromitsu Nagano
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Takashi Suda
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Hisato Ishizawa
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Takahiro Negi
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Hiroshi Kawai
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Toru Kawakami
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Daisuke Tochii
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Sachiko Tochii
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
| | - Yasushi Hoshikawa
- Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi, Japan
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Mansour DE, Lee ME, D'Souza DM, Merritt RE, Kneuertz PJ. Robotic Resection of Ectopic Parathyroid Glands in the Superior Posterior Mediastinum. J Laparoendosc Adv Surg Tech A 2019; 29:677-680. [DOI: 10.1089/lap.2018.0548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Daniel E. Mansour
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madonna E. Lee
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Desmond M. D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert E. Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J. Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Thoracoscopic removal of ectopic mediastinal parathyroid adenoma causing hyperparathyroidism: a rare entity. Wideochir Inne Tech Maloinwazyjne 2018; 13:546-550. [PMID: 30524629 PMCID: PMC6280090 DOI: 10.5114/wiitm.2018.75896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/03/2018] [Indexed: 11/29/2022] Open
Abstract
Ectopic mediastinal parathyroid adenomas are uncommon. Here, we report the successful thoracoscopic removal of a mediastinal parathyroid adenoma from a patient with hypercalcemia. A 58-year-old female patient was referred to our department with persistent hypercalcemia. Serum calcium and phosphorus levels were 13.2 mg/dl and 2.5 mg/dl respectively, while the intact parathormone level was 798.9 pg/ml. Parathyroid computed tomography revealed a solid and well-defined mass at the anterior mediastinum close to the distal aorta. Once the contrast was enhanced, our pre-diagnosis was ectopic parathyroid adenoma. The mass was detected at the anterior mediastinum, dissected free from the surrounding tissue and excised. The capsulated mass, which had a diameter of 3 × 1.5 × 0.7 cm, was confirmed as parathyroid adenoma histopathologically. Postoperative calcium and parathormone levels decreased dramatically to normal levels. Anterior mediastinal localization of an ectopic parathyroid adenoma is a rare entity. The transsternal approach is the most preferred method, but video-thoracoscopy can be used safely and effectively.
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18
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Davis TA, Yesantharao P, Ha J, Prescott JD, Yang SC. An unusual etiology of hyperparathyroidism: robotic-assisted resection of a giant functional intrathymic parathyroid cyst. J Vis Surg 2018; 4:88. [PMID: 29963377 DOI: 10.21037/jovs.2018.03.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/06/2022]
Abstract
Parathyroid cysts (PCs) are relatively rare entities, with an even smaller proportion that functionally produce parathyroid hormone (PTH). Given associated hypercalcemia, often symptomatic, as well as potentially related osteoporosis and/or nephrolithiasis, resection of these functional cysts is often indicated. This case report details the management course for a patient who presented with primary hyperparathyroidism and was ultimately found to have a functional intrathymic PC. During initial workup, 4-dimensional computed tomography (4D-CT) of the neck demonstrated enlarged left upper and right lower parathyroid glands; however, the patient's hyperparathyroid state persisted even after bilateral neck exploration and resection of these two glands. Subsequent postoperative imaging of the mediastinum revealed a large (11 cm) thymic cyst. The patient consequently underwent uneventful robotic-assisted thoracoscopic excision of the mediastinal cyst. Intraoperative blood PTH levels dropped from 734 pg/mL preoperatively to 86 pg/nL 10 minutes following resection, consistent with surgical cure by the Miami Criteria. At two months postoperatively, the patient's serum total calcium (STC) was normal at 9.2 mg/dL. Final surgical pathology noted a 15-gram parathyroid gland, with cystic degeneration. As the robot becomes further integrated into the everyday practice of thoracic surgery, we believe this approach offers advantages over conventional video-assisted thoracoscopic surgery (VATS) for mediastinal resections. Advantages include better visualization and finer, more precise dissection, especially important in this case, given the proximity of vital structures and the small, but real, risk of parathyromatosis associated with intraoperative cyst rupture.
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Affiliation(s)
- Trevor A Davis
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Pooja Yesantharao
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jinny Ha
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jason D Prescott
- Division of Endocrine Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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19
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Du H, Shi M, Zhu L, Che J, Hang J, Chen Z, Li H. Comparison of video-assisted thoracic surgery with open surgery in the treatment of ectopic mediastinal parathyroid tumors. J Thorac Dis 2018; 9:5171-5175. [PMID: 29312723 DOI: 10.21037/jtd.2017.11.60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the therapeutic effect of different surgical treatment for ectopic mediastinal parathyroid tumors and pathological features. Methods A total of 21 patients who were diagnosed with ectopic mediastinal parathyroid tumors and underwent surgeries in our department from May 1995 to May 2015 were collected and retrospectively analyzed. Results Twenty-one patients including 8 female (36.4%) and 13 male (63.6%) were collected. Among these patients, 9 cases were treated with video-assisted thoracic surgery (VATS), while 13 cases were treated with open surgery (including one secondary open operation after thoracoscopic operation). The average size of mediastinal tumors was 2.17±1.22 cm. For the post-operational pathology, 16 cases (76.2%) were diagnosed as ectopic parathyroid adenoma; 4 cases (19.0%) were diagnosed as parathyroid hyperplasia, while only 1 case (4.8%) was diagnosed as parathyroid adenocarcinoma. Conclusions Parathyroid adenoma accounts for the major pathological type of ectopic mediastinal parathyroid tumors. In addition, the correct diagnosis with precise preoperative location was the key for the treatment of ectopic mediastinal parathyroid tumors accompanied with hyperparathyroidism. Surgical intervention was demonstrated to be an effective way for the treatment of ectopic mediastinal parathyroid tumors with satisfied therapeutic outcome, especially for the VATS due to its unique clinical advantages. However, there may some difficulties when locating ectopic mediastinal parathyroid tumor less than 1 cm and the operators should be very cautious when performing thoracoscopic operations.
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Affiliation(s)
- Hailei Du
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Minmin Shi
- Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lianggang Zhu
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiamin Che
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Junbiao Hang
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhongyuan Chen
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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20
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Makay Ö, Durmaz SF, Özdemir M, Şimşir I, İçöz G, Akyıldız M. Robot-assisted endoscopic mediastinal parathyroidectomy. Turk J Surg 2018; 34:315-318. [PMID: 30664431 DOI: 10.5152/ucd.2017.3437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
Ectopic parathyroid glands can be located at any anatomical location from the base of the tongue to the mediastinum. One-third of these glands migrate deep into the mediastinum, which are not accessible with a low cervical incision. In this article, we described the robotic approach to an ectopic mediastinal parathyroid gland. This management method of mediastinal adenomas has significant advantages when compared to conventional surgery.
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Affiliation(s)
- Özer Makay
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Said F Durmaz
- Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Nederlands
| | - Murat Özdemir
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Ilgın Şimşir
- Division Endocrinology and Metabolic Diseases, Department of Internal Medicine, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Gökhan İçöz
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
| | - Mahir Akyıldız
- Division Endocrine Surgery, Department of General Surgery, Ege University School of Medicine Hospital, İzmir, Turkey
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21
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Ishikawa M, Sumitomo SI, Imamura N, Nishida T, Mineura K. A rare case of mediastinal functioning parathyroid adenoma removed successfully with thoracoscopy. J Surg Case Rep 2017; 2017:rjx070. [PMID: 28458875 PMCID: PMC5400454 DOI: 10.1093/jscr/rjx070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/25/2017] [Indexed: 01/07/2023] Open
Abstract
We report here a rare case of primary hyperparathyroidism that was associated with an ectopic parathyroid adenoma located in the mediastinum. A 66-year-old woman suffering from primary hyperparathyroidism had been followed-up on an outpatient basis for over 10 years. She suffered from persistent urolithiasis and osteopenia due to hypercalcemia. After technetium-99-sestamibi (99mTc-MIBI) scintigraphy revealed an ectopic adenoma in the superior mediastinum, thoracoscopic resection of the tumor was performed. Subsequently, her serum parathyroid hormone (PTH) level decreased dramatically and her serum calcium concentration was restored to normal. Two years following surgery, her serum PTH and Ca levels remain stable.
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Affiliation(s)
- Masashi Ishikawa
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Shin-Ichi Sumitomo
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Naoto Imamura
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Tomoki Nishida
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Katsutaka Mineura
- Department of Thoracic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
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22
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Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism. J Robot Surg 2016; 11:163-169. [DOI: 10.1007/s11701-016-0637-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
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23
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Revisiting robotic approaches to endocrine neoplasia: do the data support their continued use? Curr Opin Oncol 2016; 28:26-36. [PMID: 26632768 DOI: 10.1097/cco.0000000000000245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Although the advent of the robot has revolutionized the modern treatment of endocrine neoplasia, substantial controversies exist on its applicability, safety and benefits over the conventional laparoscopic operations. The present review aims to review the recent literature on various robotic approaches in treating thyroid, parathyroid, adrenal and pancreatic endocrine neoplasia and see whether its continued use should be supported. RECENT FINDINGS In summary, the role of robotic thyroidectomy has been clearly established and should be continued by experienced surgeons on selected patients. Because of the limited availability of evidence, the feasibility of robotic parathyroidectomy has yet to be elucidated. With proven favorable perioperative outcomes, robotic adrenalectomy and pancreatectomy should be continued as potential alternatives to conventional surgery. SUMMARY Robotic endocrine procedures still play a pivotal role in minimally invasive endocrine surgery with demonstrable safety and effectiveness. Future research should embark on prospective randomized-controlled trials on robotic endocrine procedures to collect higher level of evidence and long-term survival data.
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Brunaud L, Li Z, Van Den Heede K, Cuny T, Van Slycke S. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg 2016; 5:352-60. [PMID: 27294044 DOI: 10.21037/gs.2016.01.06] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations.
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Affiliation(s)
- Laurent Brunaud
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Zhen Li
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Klaas Van Den Heede
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Thomas Cuny
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Sam Van Slycke
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
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25
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Libánský P, Yershov D, Adámek S, Šimonek J, Fialová M, Kubinyi J, Lischke R. Video-assisted mediastinoscopic removal of ectopic parathyroid adenoma combined with standard cervical exploration. Eur Surg 2016. [DOI: 10.1007/s10353-016-0413-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Abstract
In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a "no-touch" technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive approaches. Furthermore, increased robotic experience and studies, including randomized controlled trials, are needed to validate the findings of the current literature.
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, 1 Chief of Robotic Multispecialities Center for Surgery, 2 CardioThoracic and Vascular Department, 3 Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, Italy
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Mohamed HE, Bhatia P, Aslam R, Moulthrop T, Kandil E. Robotic transaxillary and retroauricular parathyroid surgery. Gland Surg 2015; 4:420-8. [PMID: 26425455 DOI: 10.3978/j.issn.2227-684x.2015.04.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.
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Affiliation(s)
- Hossam Eldin Mohamed
- 1 Department of Surgery, 2 Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Parisha Bhatia
- 1 Department of Surgery, 2 Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Rizwan Aslam
- 1 Department of Surgery, 2 Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Thomas Moulthrop
- 1 Department of Surgery, 2 Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- 1 Department of Surgery, 2 Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, USA
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28
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Tonelli F, Biagini C, Giudici F, Cioppi F, Brandi ML. Aortopulmonary window parathyroid gland causing primary hyperparathyroidism in men type 1 syndrome. Fam Cancer 2015; 15:133-8. [PMID: 26394783 DOI: 10.1007/s10689-015-9840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Primary hyperparathyroidism (HPT) is the most common endocrinopathy in Multiple Endocrine Neoplasia type 1 (MEN1) syndrome. Supernumerary and/or ectopic parathyroid glands, potentially causes of persistent or recurrent HPT after surgery, have been previously described. However, this is the first ever described case of ectopic parathyroid gland localized in the aortopulmunary window causing HPT in MEN1. After a consistent concordant pre-operative imaging assessment the patient, a 16 years old male affected by a severe hypercalcemia, underwent surgery. The parathyroid was found very deeply near the tracheal bifurcation, hidden by the aortic arch itself and for this reason not visible at the beginning of the dissection but only after being identified by palpation for its typical consistence. The intraoperative PTH decreased at normal level 10 min after removal of the ectopic gland. The patient remained with normal value of calcemia and PTH during the 10 months of follow-up.
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Affiliation(s)
- Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy.
| | - Carlo Biagini
- Signa Diagnostic Centre of Public Health Assistence, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
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29
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Straughan DM, Fontaine JP, Toloza EM. Robotic-Assisted Videothoracoscopic Mediastinal Surgery. Cancer Control 2015; 22:326-30. [PMID: 26351888 DOI: 10.1177/107327481502200310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tumors of the mediastinum as well as normal thymus glands in patients with myasthenia gravis have traditionally been resected using large and morbid incisions. However, robotic-assisted mediastinal resections are gaining popularity because of the many advantages that the robot provides. However, few comprehensive reviews of the literature on robotic-assisted mediastinal resections exist. METHODS A systemic review of the current medical literature was performed, excluding cases related to esophageal pathology. These studies were evaluated and their findings are reported in this comprehensive review. Approximately 48 papers met the inclusion criteria for review. RESULTS Robotic-assisted surgical systems are increasingly being used in mediastinal resections. Based on the available literature, robotic-assisted thoracoscopic surgery in the mediastinum is feasible and safe. Robotic-assisted mediastinal surgery appears to be superior to open approaches of the mediastinum and is comparable with videothoracoscopic surgery when patient outcomes are considered. CONCLUSIONS Increased robotic experience and more studies, including randomized controlled trials, are needed to validate the findings of the current literature.
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Affiliation(s)
- David M Straughan
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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30
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Okoh AK, Sound S, Berber E. Robotic parathyroidectomy. J Surg Oncol 2015; 112:240-2. [PMID: 26073748 DOI: 10.1002/jso.23911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 02/28/2015] [Indexed: 11/07/2022]
Abstract
Robotic parathyroidectomy has recently been described. Although the procedure eliminates the neck scar, it is technically more demanding than the conventional approaches. This report is a review of the patients' selection criteria, technique, and outcomes.
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Affiliation(s)
- Alexis Kofi Okoh
- Department Of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sara Sound
- Department Of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eren Berber
- Department Of General Surgery, Cleveland Clinic, Cleveland, Ohio
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Sridhar P, Steenkamp DW, Lee SL, Ebright MI, Litle VR, Fernando HC. Mediastinal Parathyroid Adenoma with Osteitis Fibrosis Cystica: Robot-Assisted Thoracic Surgical Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:445-7. [DOI: 10.1177/155698451400900609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mediastinal parathyroid adenomas can be resected by sternotomy or video-assisted thoracoscopic surgery. Robot-assisted thoracic surgical approaches have recently been described. We report robotassisted thoracic surgical resection of a mediastinal parathyroid in a morbidly obese patient. Additional comorbidities included multiple pathological fractures related to hypercalcemia. Intraoperative parathyroid hormone levels confirmed successful removal of the adenoma. Hungry bone syndrome developed after surgery but eventually resolved. Robotassisted thoracic surgery avoided the need for sternotomy and associated concerns related to poor bone healing. Robot-assisted thoracic surgery has potential advantages over video-assisted thoracoscopic surgery in patients with obesity because of easier instrument articulation within the thoracic cavity rather than at the chest wall.
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Affiliation(s)
- Praveen Sridhar
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Devin W. Steenkamp
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Stephanie L. Lee
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Michael I. Ebright
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Virginia R. Litle
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Hiran C. Fernando
- Boston University School of Medicine, Boston Medical Center, Boston, MA USA
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Lu HI, Chou FF, Chi SY, Huang SC. Thoracoscopic Removal of Hypertrophic Mediastinal Parathyroid Glands in Recurrent Secondary Hyperparathyroidism. World J Surg 2014; 39:400-9. [DOI: 10.1007/s00268-014-2797-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Robotic surgery for primary hyperparathyroidism. Surg Endosc 2014; 28:2702-7. [PMID: 24771196 DOI: 10.1007/s00464-014-3531-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Open cervical parathyroidectomy is the standard of care for the treatment of primary hyperparathyroidism (PHP). However, in patients with a history of keloid or hypertrophic scar formation, the cosmetic result may sometimes be unsatisfactory. Furthermore, in the presence of mediastinal glands, a more morbid approach is sometimes necessary, involving a sternal split or thoracotomy. Robotic parathyroidectomy, either transaxillary or transthoracic, could be an alternative in both settings. METHODS Between 2008 and 2013, 14 patients with PHP and a well-localized single adenoma underwent robotic transaxillary cervical (TAC) (n = 8) or transthoracic mediastinal (TTM) (n = 6) parathyroidectomy at an academic tertiary medical center and their outcomes were analyzed. RESULTS All 14 operations were completed successfully as planned. For TAC and TTM parathyroidectomies, mean operative time was 184 and 168 min, respectively. With the exception of one TTM patient, intraoperative PTH determination indicated a >50 % drop in all patients 10 min after excision and no patients presented with recurrent disease on follow-up. Average length of hospital stay was 1 day after TAC parathyroidectomy and 2.2 days after TTM. On a visual analog pain scale (0-10), average pain scores after TAC were 6/10 on postoperative day 1 and 1/10 on day 14, compared to 7.7/10 and 1.5/10, respectively, after TTM. Complications included development of seroma in 1 patient in the TAC group and pericardial and pleural effusion in 1 patient in the TTM cohort. CONCLUSIONS 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.
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Schwarzlmüller T, Brauckhoff K, Løvås K, Biermann M, Brauckhoff M. High cardiac background activity limits 99mTc-MIBI radioguided surgery in aortopulmonary window parathyroid adenomas. BMC Surg 2014; 14:22. [PMID: 24758398 PMCID: PMC4003509 DOI: 10.1186/1471-2482-14-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radioguided surgery using 99m-Technetium-methoxyisobutylisonitrile (99mTc-MIBI) has been recommended for the surgical treatment of mediastinal parathyroid adenomas. However, high myocardial 99mTc-MIBI uptake may limit the feasibility of radioguided surgery in aortopulmonary window parathyroid adenoma. CASE PRESENTATION Two female patients aged 72 (#1) and 79 years (#2) with primary hyperparathyroidism caused by parathyroid adenomas in the aortopulmonary window were operated by transsternal radioguided surgery. After intravenous injection of 370 MBq 99mTc-MIBI at start of surgery, the maximum radioactive intensity (as counts per second) was measured over several body regions using a gamma probe before and after removal of the parathyroid adenoma. Relative radioactivity was calculated in relation to the measured ex vivo radioactivity of the adenoma, which was set to 1.0. Both patients were cured by uneventful removal of aortopulmonary window parathyroid adenomas of 4400 (#1) and 985 mg (#2). Biochemical cure was documented by intraoperative measurement of parathyroid hormone as well as follow-up examination. Ex vivo radioactivity over the parathyroid adenomas was 196 (#1) and 855 counts per second (#2). Before parathyroidectomy, relative radioactivity over the aortopulmonary window versus the heart was found at 1.3 versus 2.6 (#1) and 1.8 versus 4.8 (#2). After removal of the adenomas, radioactivity within the aortopulmonary window was only slightly reduced. CONCLUSION High myocardial uptake of 99mTc-MIBI limits the feasibility of radioguided surgery in aortopulmonary parathyroid adenoma.
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Affiliation(s)
- Thomas Schwarzlmüller
- Department of Radiology, Centre for Nuclear Medicine/PET, Haukeland University Hospital, Jonas Liesvei 65, Bergen 5021, Norway.
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Robotic Surgery in Otolaryngology: Endocrine. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ismail M, Swierzy M, Ulrich M, Rückert J. Anwendung des daVinci-Robotersystems in der Thoraxchirurgie. Chirurg 2013; 84:643-50. [DOI: 10.1007/s00104-013-2502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: current status and prospects. Gen Thorac Cardiovasc Surg 2012. [PMID: 23197160 DOI: 10.1007/s11748-012-0185-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The most favorable advantage of robotic surgery is the markedly free movement of joint-equipped robotic forceps under 3-dimensional high-vision. Accurate operation makes complex procedures straightforward, and may overcome weak points of the previous thoracoscopic surgery. The efficiency and safety improves with acquiring skills. However, the spread of robotic surgery in the general thoracic surgery field has been delayed compared to those in other fields. The surgical indications include primary lung cancer, thymic diseases, and mediastinal tumors, but it is unclear whether the technical advantages felt by operators are directly connected to merits for patients. Moreover, problems concerning the cost and education have not been solved. Although evidence is insufficient for robotic thoracic surgery, it may be an extension of thoracoscopic surgery, and reports showing its usefulness for primary lung cancer, myasthenia gravis, and thymoma have been accumulating. Advancing robot technology has a possibility to markedly change general thoracic surgery.
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Affiliation(s)
- Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
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Robotic surgery in otolaryngology and head and neck surgery: a review. Minim Invasive Surg 2012; 2012:286563. [PMID: 22567225 PMCID: PMC3337488 DOI: 10.1155/2012/286563] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/04/2012] [Indexed: 01/12/2023] Open
Abstract
Recent advancements in robotics technology have allowed more complex surgical procedures to be performed using minimally invasive approaches. In this article, we reviewed the role of robotic assistance in Otolaryngology and Head and Neck Surgery. We highlight the advantages of robot-assisted surgery and its clinical application in this field.
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Brunaud L, Reibel N, Ayav A. Pancreatic, endocrine and bariatric surgery: the role of robot-assisted approaches. J Visc Surg 2011; 148:e47-53. [PMID: 21978931 DOI: 10.1016/j.jviscsurg.2011.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- L Brunaud
- Service de chirurgie digestive, hépato-biliaire et endocrinienne, hôpital Brabois-Adultes, CHU de Nancy, 11, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
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Genc V, Agcaoglu O, Berber E. Robotic endocrine surgery: technical details and review of the literature. J Robot Surg 2011; 6:85-97. [PMID: 27628272 DOI: 10.1007/s11701-011-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022]
Abstract
Over the last decade, robotic technology has been used in multiple general surgical procedures. Endocrine surgeons have embraced this technology and subsequently transformed neck operations into more cosmetically acceptable procedures and improved ergonomics. Technical details of various robotic endocrine surgical procedures have recently been described. The aim of this review is to illustrate these technical details and analyze the current data to propose an evidence-based approach to robotic endocrine surgery.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Agcaoglu
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA
| | - Eren Berber
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
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Van Dessel E, Hendriks JMH, Lauwers P, Ysebaert D, Ruyssers N, Van Schil PEY. Mediastinal Parathyroidectomy with the da Vinci Robot. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Els Van Dessel
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | | | - Patrick Lauwers
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - Dirk Ysebaert
- Hepatobi-liary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
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Mediastinal Parathyroidectomy with the da Vinci Robot. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:262-4. [PMID: 22437986 DOI: 10.1097/imi.0b013e31822c5a4a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Tolley N, Arora A, Palazzo F, Garas G, Dhawan R, Cox J, Darzi A. Robotic-Assisted Parathyroidectomy. Otolaryngol Head Neck Surg 2011; 144:859-66. [DOI: 10.1177/0194599811402152] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective. Targeted parathyroidectomy is the gold standard for localized parathyroid disease. A robotic-assisted approach has not been investigated. The aim was to assess the feasibility of a robotic technique that avoids a neck scar. Study Design. Feasibility study. Setting. Tertiary referral center. Subjects and Methods. Eleven patients with primary hyperparathyroidism were prospectively evaluated. Triple modality concordant localization was a prerequisite. All patients underwent robotic-assisted parathyroidectomy (RAP). Outcome variables assessed were operative time, voice change, biochemical cure, and histopathological confirmation. Patient-reported outcome measures (PROMs) included subjective assessment of pain and scar cosmesis, Voice Handicap Index 2, and EQ-5D quality-of-life assessment. Mean follow-up was 6 months (range, 3-12 months). Results. The parathyroid adenoma was successfully excised in all cases with negligible blood loss (<5 mL). There was 1 conversion. There was no voice change in any case. Robot docking time plateaued to 10 minutes after 8 cases. Mean exposure and console times (31 and 51 minutes, respectively) were affected by body habitus. The mean visual analog scale for scar cosmesis was 75% on the first postoperative day, improving to 92% at 6 months and 95% at 1 year. Pain scores decreased to 8% at 2 weeks. All 5 EQ-5D quality-of-life parameters significantly improved following surgery. Conclusion. The robotic approach is feasible for performing targeted parathyroidectomy that avoids a neck scar. The clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted parathyroidectomy warrant further evaluation to establish if this represents a viable alternative to the existing targeted techniques.
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Affiliation(s)
- Neil Tolley
- Department of Otorhinolaryngology and Head & Neck Surgery, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Asit Arora
- Department of Otorhinolaryngology and Head & Neck Surgery, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fausto Palazzo
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - George Garas
- Department of Otorhinolaryngology and Head & Neck Surgery, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ranju Dhawan
- Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jeremy Cox
- Department of Endocrinology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ara Darzi
- Department of Biosurgery and Surgical Technology, St Mary’s Hospital, Imperial College London, London, UK
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Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study. J Thorac Cardiovasc Surg 2011; 141:673-7. [DOI: 10.1016/j.jtcvs.2010.11.042] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 11/17/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Arora A, Cunningham A, Chawdhary G, Vicini C, Weinstein GS, Darzi A, Tolley N. Clinical applications of Telerobotic ENT-Head and Neck surgery. Int J Surg 2011; 9:277-84. [DOI: 10.1016/j.ijsu.2011.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/15/2011] [Accepted: 01/20/2011] [Indexed: 11/29/2022]
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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