Robot-Assisted Thoracoscopic Mediastinal Parathyroidectomy: A Single Surgeon Case Series

Minimally invasive (video-assisted thoracoscopic surgery) mediastinal parathyroidectomy has been described as a technique for surgical management of primary hyperparathyroidism due to ectopic parathyroid adenoma. Herein, we present the largest cohort of patients (n = 8) treated with robot-assisted mediastinal parathyroidectomy and describe our technique for this procedure, pre- and intraoperative variables, and postoperative outcomes. A single surgeon, single institution case series of eight consecutive robot-assisted mediastinal parathyroidectomies performed from April 2013 to March 2018. Preoperative workup, intraoperative variables, and postoperative outcomes were evaluated. Of the eight patients, seven were women. Average age was 54 years (range: 28-69) and average body mass index 33.6 (range: 24.8-42.9). Seven patients had a preoperative diagnosis of primary hyperparathyroidism with preoperative parathyroid hormone (PTH) and calcium levels (PTH: 137 (70-192); Ca²⁺: 10.9 (10.2-12), and one patient had preoperative diagnosis of thymoma. Preoperative imaging studies included computed tomography (CT)-sestamibi (n = 3), CT neck (n = 4), CT chest (n = 6), and neck ultrasound (n = 6). Intraoperative PTH measurements found >50% reduction in all cases. Average length of surgery was 108.6 minutes (range: 76-186); average blood loss 26 cc. All specimens were parathyroid adenomas, with an average size of 16 mm (range: 7-35 mm). Seven of eight patients were discharged on postoperative day 1. No complications or recurrences occurred at a median follow-up of 18.5 days (range: 15-1,066 days). Robot-assisted thoracoscopic parathyroidectomy is a safe and effective technique, with immediate improvement in PTH levels. Thorough clinical, biochemical, and radiologic preoperative workup assists in operative planning and may improve diagnostic accuracy of anterior mediastinal masses.