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Objective: Patients with parathyroid adenomas generally present with enlargement of one of the four cervical parathyroid glands. Our patient presented with symptoms as well as laboratory and imaging studies consistent with a mediastinal parathyroid adenoma. After explaining the risks and benefits of open versus minimally invasive approaches, our patient opted for a robotic-assisted, minimally invasive approach for resection.
Methods: After informed consent was obtained and anesthesia was induced, our patient was placed in the supine position on the operating table with a bump under her right shoulder. An incision was made at the right third intercostal space at midclavicular line for the camera port. The right lung was deflated, the camera inserted, and CO2 insufflation was induced to expand the right chest. Working ports were then placed an interspace above and an interspace below the camera port. The adenoma was visualized in the thymic fat just over the ascending aorta and excised using primarily electrocautery. Care was taken to not disrupt or handle the adenoma. An endobag was inserted via the right arm port and the adenoma was retrieved and sent to pathology. The surgical incisions were closed and the patient was awakened from anesthesia and taken to the recovery room in stable condition.
Results: Pathology demonstrated an enlarged and hypercellular parathyroid consistent with adenoma. Parathyroid hormone level decreased from 101 pg/ml preoperatively to 30 pg/ml immediately postoperatively. The patient was discharged without incident on the second postoperative day.
Conclusions: Robotic-assisted resection is a safe and expedient alternative to open resection for mediastinal parathyroid adenomas not accessible via a cervical approach.