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Robotic Assisted Resection Of Ectopic Parathyroid Adenoma - Standardising The Surgical Approach
Nikolaos Panagiotopoulos, W James B Smellie;
Cleveland Clinic, London, United Kingdom
BACKGROUND:Ectopic parathyroid adenomas located in the mediastinum represent a rare clinical entity and should be considered in the differential diagnosis for mediastinal tumours. Median sternotomy or lateral thoracotomy used to be the standard approach for these lesions especially if located in the lower anterior mediastinum.
METHODS:The introduction of the Da Vinci Robotic System has revolutionised minimally invasive surgery and is associated with better visualisation by magnification, instrumentation and better outcomes by minimising hospital stay, enhancing recovery and a better cosmetic result. In this presentation we discuss the radiological findings, symptoms and surgical approach for a 26-year old female patient presenting in our department with an anterior mediastinal ectopic parathyroid adenoma. Preoperative imaging was used along with biochemical testing to confirm the diagnosis of hyperparathyroidism and confirm single gland disease.
RESULTS:The surgical technique is similar for all anterior mediastinal masses and we recommend approach from the right side/ pleural cavity. The patient is positioned supine and slightly tilted to the left side. 3 small incisions of 8mm each are performed for the insertion of the robotic arms. The 30-degree camera is inserted through the anterior axillary line incision - 8th space. The monopolar scissors in the same space anteriorly and parasternally. Bipolar forceps instrument is inserted at 4th space mid axillary line. With the lung isolation and CO2 insufflation the mediastinum is exposed, and all sensitive structures are easily visualised. In our experience the ectopic parathyroid can be easily visualised dissecting into the thymic tissue and can be resected with the capsule intact and surrounded by normal thymic tissue. Intraoperative measurement of PTH and calcium confirms complete resection. A 24F chest drain is inserted for 1 day and patient can be discharged home within 24 to 48hours.
CONCLUSIONS:Standardising the robotic approach for the resection of ectopic parathyroid adenomas represent a modern and safe technique associated with excellent outcome, recovery and cosmetic result.
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