Mediastinal parathyroidectomy with the da Vinci robot

Area of Science:

• Endocrinology
• Thoracic Surgery
• Surgical Robotics

Background:

• Mediastinal parathyroid glands present a surgical challenge due to their location, often inaccessible via cervical approaches.
• Minimally invasive techniques are crucial to reduce morbidity associated with open surgery for these aberrant glands.

Purpose of the Study:

• To present two cases of successful parathyroidectomy for mediastinal parathyroid adenomas using the da Vinci robotic system.
• To highlight the efficacy and feasibility of robotic-assisted surgery for challenging parathyroidectomies.

Main Methods:

• Two patients with primary hyperparathyroidism and mediastinal parathyroid adenomas underwent robotic-assisted parathyroidectomy via a left-sided thoracoportal approach.
• The procedure involved insertion of thoracoports, single-lung ventilation, and dissection within the mediastinum, guided by the robotic system.
• Intraoperative confirmation included frozen section analysis and rapid parathyroid hormone level assessment.

Main Results:

• Successful resection of mediastinal parathyroid adenomas was achieved in both cases using the da Vinci robotic system.
• The robotic approach facilitated precise dissection and visualization in the mediastinal region.
• Histopathological and biochemical analyses confirmed the diagnosis and successful removal of the adenomas.

Conclusions:

• Robotic-assisted parathyroidectomy is a viable and effective minimally invasive option for treating mediastinal parathyroid adenomas.
• This approach offers advantages in terms of visualization and dissection precision, particularly for adenomas located in the aortopulmonary window.
• Further research into robotic applications for endocrine surgery is warranted.