Robotic-Assisted Transaxillary Parathyroidectomy: A Safe and Cosmetically Alternative for Primary Hyperparathyroidism

This study aimed to describe the initial experience with robot-assisted transaxillary parathyroidectomy (RATP) and to investigate its safety and efficacy as a surgical approach for the treatment of primary hyperparathyroidism (PHPT). With the advent of robotic head and neck surgery, there is growing interest in the application of robotic technology to improve cosmetic outcomes and surgical precision.

A retrospective analysis was conducted on 20 patients who underwent parathyroidectomy from June 2020 to January 2024. Patients were divided into two groups based on surgical approach: the robotic group (n = 8), who underwent robot-assisted axillary approach parathyroidectomy, and the open group (n = 12), who underwent conventional open parathyroidectomy. Surgical outcomes, biochemical parameters, cosmetic results, and complications were compared between the two groups.

Both groups demonstrated comparable levels of intraoperative blood loss and postoperative reductions in parathyroid hormone (PTH) and calcium levels. While the robotic group had a significantly longer operative time ([109.3 ± 30.1] vs. [76.2 ± 32.9] min, p = 0.037), there were no significant differences in postoperative complications, recovery trajectories, or biochemical marker normalization. The robotic group exhibited significantly lower postoperative Scar Cosmesis Assessment and Rating (SCAR) scores (2.25 ± 0.5 vs. 3.2 ± 0.8, p = 0.011), indicating improved cosmetic outcomes and patient satisfaction.

RATP is a safe and cosmetically surgical option for the treatment of PHPT, offering superior cosmetic outcomes compared to the conventional open approach. Although the operative duration was longer in the robotic group, this did not translate into differences in postoperative complications, recovery, or biochemical marker normalization. Therefore, RATP can be considered a new and promising alternative to parathyroid surgery.