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Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism
Laurent Brunaud1, Zhen Li1, Klaas Van Den Heede1
11 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.
Minimally invasive parathyroidectomy using endoscopic or robotic approaches offers benefits like reduced pain and improved cosmesis for primary hyperparathyroidism (PHPT). However, robot-assisted techniques require further study, while endoscopic methods show clear advantages over open surgery.
Area of Science:
- Endocrine Surgery
- Minimally Invasive Surgical Techniques
- Surgical Oncology
Background:
- Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
- Parathyroidectomy is the definitive treatment for PHPT.
- Historically, open four-gland exploration was standard, but focused exploration is now preferred due to single-gland pathology prevalence.
Purpose of the Study:
- To review current data on endoscopic and robotic-assisted parathyroidectomy for PHPT.
- To compare these minimally invasive approaches with conventional open surgery.
- To evaluate the efficacy and patient outcomes of advanced surgical techniques in PHPT management.
Main Methods:
- Systematic review of comparative studies on endoscopic, video-assisted, and robot-assisted parathyroidectomy.
- Analysis of data regarding postoperative pain, cosmetic results, patient satisfaction, and surgical dissection.
- Evaluation of suitability for ectopic mediastinal parathyroid glands.
Main Results:
- Endoscopic and video-assisted parathyroidectomy show reduced postoperative pain, better cosmetic outcomes, and higher patient satisfaction compared to open minimally invasive surgery.
- Robot-assisted transaxillary parathyroidectomy offers scarless neck results but involves more extensive dissection and requires further research.
- Endoscopic and robot-assisted thoracoscopic approaches are suitable for ectopic mediastinal parathyroid glands.
Conclusions:
- Minimally invasive endoscopic techniques provide significant advantages for parathyroidectomy in PHPT patients.
- Robot-assisted surgery shows promise, particularly for specific anatomical challenges, but needs more evidence.
- Surgical approach selection should consider patient factors and gland location for optimal outcomes in PHPT treatment.
