Case Series: Single-port subxiphoid robotic excision of ectopic mediastinal parathyroid adenomas

Ectopic mediastinal parathyroid adenomas are a rare cause of persistent primary hyperparathyroidism and present operative challenges due to proximity to major mediastinal structures. Robotic trans-subxiphoid resection using multi-port platforms has been described; however, experience with a true uniportal single-port robotic approach remains limited.

We report a case series of two patients with biochemically confirmed primary hyperparathyroidism and imaging-localized anterior mediastinal parathyroid adenomas who underwent excision using a single-port subxiphoid robotic technique with the da Vinci SP system. Operative variables, intraoperative parathyroid hormone (PTH) response, perioperative outcomes, and pathology were analyzed.

Single-port subxiphoid robotic excision was completed successfully in 100% (2/2) of cases with no conversions and no intraoperative complications. Mean operative time was 150 min (170 and 130 min), and estimated blood loss was <50 mL in both cases. Critical structures, including the innominate vein and bilateral phrenic nerves, were clearly visualized and preserved. Intraoperative PTH levels decreased by >80% at 10 min post-excision in both patients, meeting Miami criteria. PTH decreased from 172 pg/mL to 22 pg/mL in one patient and from 296 pg/mL to 99 pg/mL, with subsequent normalization, in the other. Both patients were discharged on postoperative day one with normalization of ionized calcium at 1-week follow-up. Final pathology confirmed parathyroid adenoma in both cases.

This series demonstrates the safety and feasibility of a true uniportal single-port subxiphoid robotic approach for ectopic mediastinal parathyroid adenomas and highlights its potential as a highly minimally invasive alternative for selected patients.