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Paspala A, Spartalis E, Nastos C, Tsourouflis G, Dimitroulis D, Pikoulis E, Nikiteas N. Robotic-assisted parathyroidectomy and short-term outcomes: a systematic review of the literature. J Robot Surg 2020; 14:821-827. [PMID: 32661866 DOI: 10.1007/s11701-020-01119-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
Minimal invasive techniques in endocrine surgery were lately adopted by surgical teams due to significant complications related to inadequate operative space and high risk of injuring crucial surrounding structures, such as vessels and nerves. Over the last years, technological improvements introduced robotic systems and approaches in endocrine surgery. Several case reports and series have described the safety and efficacy of these procedures such as robotic thyroidectomy and robotic parathyroidectomy. In the current review, we included 15 studies which described robotic-assisted parathyroidectomy for cervical parathyroid adenoma, in patients diagnosed with primary hyperparathyroidism or secondary hyperparathyroidism. No significant negative short-term outcomes were observed, in terms of postoperative complications, such as temporary or permanent injury of RLN, postoperative hypoparathyroidism and blood loss. The cosmetic result was, definitely, superior in comparison to conventional open parathyroidectomy. Despite the fact that RAP is an effective and curative method for patients with PHPT or secondary hyperparathyroidism, there are no available randomized clinical trials to establish this modern procedure as a gold-standard treatment strategy for these patients.
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Affiliation(s)
- A Paspala
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece.
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | - C Nastos
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Pikoulis
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bhargav PRK, Sabaretnam M, Amar V, Devi NV. Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: A South Indian experience. J Minim Access Surg 2019; 15:119-123. [PMID: 29737315 PMCID: PMC6438068 DOI: 10.4103/jmas.jmas_264_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/18/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Primary hyperparathyroidism is one of the most common endocrine disorders requiring surgical parathyroidectomy for its definitive treatment. Surgical exploration is traditionally performed through conventional open neck approach. A wide range of minimal access and minimally invasive endoscopic techniques (gas less and with gas) have been attempted in the past two decades. In this context, we evaluated the feasibility and safety of an innovative transoral endoscopic parathyroidectomy (EP) technique, which represents a paradigm shift in transluminal endocrine surgery. Materials and Methods This is a prospective study conducted at a tertiary care Endocrine Surgery Department in South India between May 2016 and August 2017. We employed a novel transoral, lower vestibular route for EP. All the clinical, investigative, operative, pathological and post-operative data were collected from our prospectively filled database. Statistical analysis was performed with SPSS 20.0 version. Operative Technique Under inhalational general anaesthesia, access to the neck was obtained with 3 ports (central frenulotomy and two lateral port sites), dissected in subplatysmal plane and insufflated with 6 mm Hg CO2 for working space. Rest of surgical steps is similar to conventional open parathyroidectomy. Results Out of the 38 hyperparathyroidism cases operated during the study, 12 (32%) were operated by this technique. Mean operative time was 112 ± 15 min (95-160). The post-operative course was uneventful with no major morbidity, hypocalcemia or recurrent laryngeal nerve palsy. Cure and diagnosis were confirmed by >50% fall in intraoperative parathyroid hormone levels and histopathology (all were benign solitary adenomas). Conclusions Through this study, we opine that this novel transoral vestibular route parathyroidectomy is a feasibly applicable approach for primary sporadic hyperparathyroidism, especially with solitary benign adenomas.
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Affiliation(s)
- P. R. K. Bhargav
- Department of Endocrine Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India
| | - M. Sabaretnam
- Department of Endocrine Surgery SGPGIMS, Lucknow, Uttar Pradesh, India
| | - V. Amar
- Department of Bariatric and Metabolic Surgery, Apollo Hospital, Hyderabad, Telangana, India
| | - N. Vimala Devi
- Department of Endocrine Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India
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Ozdenkaya Y, Ersavas C, Arslan NC. Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature. World J Clin Cases 2018; 6:542-547. [PMID: 30397611 PMCID: PMC6212607 DOI: 10.12998/wjcc.v6.i12.542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.
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Affiliation(s)
- Yasar Ozdenkaya
- Department of General Surgery, Medipol University, Istanbul 34214, Turkey
| | - Cenk Ersavas
- Department of General Surgery, Medipol University, Istanbul 34214, Turkey
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Sasanakietkul T, Carling T. Primary hyperparathyroidism treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). Surg Endosc 2017; 31:4832-4833. [PMID: 28409372 DOI: 10.1007/s00464-017-5533-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bilateral open cervical exploration with identifying all parathyroid glands and removing one or more enlarged parathyroid tumor(s) was the standard of care in primary hyperparathyroidism (pHPT). With the introduction of preoperative imaging and intraoperative parathyroid hormone (IOPTH) measurements [1, 2], various minimally invasive parathyroidectomy approaches have been developed, both open and endoscopic [3-8]. The most commonly used approach currently in the USA is the minimally invasive open parathyroidectomy (MIP), which can be performed in the ambulatory setting with excellent cure and minimal complication rates [9-12]. However, the operation requires a cervical incision, with occasionally poor cosmesis. The transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) provides a novel "scarless" approach to parathyroid surgery. METHODS The aim of the video is to provide detailed instruction of the TOEPVA in pHPT and how to interpret IOPTH measurements in this setting. RESULTS The TOEPVA uses three incisions in the vestibule of the oral cavity, using two 5-mm ports and one central 11-mm port. The subplatysmal space is enlarged by hydrodissection and manual dilation. The working space is enhanced by insufflation to 6 mmHg. With the adjunct of preoperative imaging and IOPTH measurements, the extent of the operation is tailored to achieve biochemical cure. CONCLUSIONS TOEPVA is feasible and safe and provides an excellent cosmetic outcome. It is a more direct approach than other remote endoscopic parathyroidectomy techniques. TOEPVA is an excellent option for select patients with pHPT wishing to avoid a neck incision.
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Affiliation(s)
- Thanyawat Sasanakietkul
- Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, 333 Cedar Street, FMB130A, Box 208062, New Haven, CT, 06520, USA
| | - Tobias Carling
- Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, 333 Cedar Street, FMB130A, Box 208062, New Haven, CT, 06520, USA.
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Kurganov IA, Emelyanov SI, Bogdanov DY, Agafonov OA, Mamistvalov MS, Matveev NL, Fedorov AV, Kusin AN. [Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study)]. Khirurgiia (Mosk) 2017:32-36. [PMID: 29186094 DOI: 10.17116/hirurgia20171132-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach. MATERIAL AND METHODS The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed. RESULTS Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases. CONCLUSION Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.
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Affiliation(s)
- I A Kurganov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - S I Emelyanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - D Yu Bogdanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - O A Agafonov
- Tsentrosoyuz Hospital of the Russian Federation, Moscow, Russia ,Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - M Sh Mamistvalov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - N L Matveev
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A V Fedorov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A N Kusin
- Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
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Cai C, Huang Y, Zhang T, Chai L, Wang G, Shi L, Wiegand S, Güldner C, Günzel T, Wilhelm T. Anatomical study of surgical approaches for minimally invasive transoral thyroidectomy: eMIT and TOPP. MINIM INVASIV THER 2015; 24:340-4. [PMID: 25854280 DOI: 10.3109/13645706.2015.1034728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility. MATERIAL AND METHODS After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed. RESULTS The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (<20 mm in diameter) and current surgical instruments still did not match the requirement of this technique. CONCLUSIONS This study demonstrated that the transoral approach of eMIT is anatomically safer and more feasible than that of TOPP.
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Affiliation(s)
- Chengzhong Cai
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China.,b 2 Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences , W. Markham St. Slot# 543, Little Rock, AR 72205, USA
| | - Yixiang Huang
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China
| | - Ti Zhang
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China
| | - Li Chai
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China
| | - Gang Wang
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China
| | - Linxiang Shi
- a 1 Department of General Surgery, Tenth People's Hospital of Tongji University , Shanghai, P.R. China
| | - Susanne Wiegand
- c 3 Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg , Marburg, Germany
| | - Christian Güldner
- c 3 Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg , Marburg, Germany
| | - Thomas Günzel
- d 4 Department of Otolaryngology, Head and Neck Surgery , Frankfurt/Oder, Germany
| | - Thomas Wilhelm
- e 5 Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land GmbH , Sana Klinikum Borna, Germany
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