Abstract
One to two percent of ectopic parathyroid adenomas are found in the lower mediastinum and often these are best accessed via a sternotomy or thoracotomy. Video-assisted thoracoscopic surgery (VATS) is an alternative approach with less surgical trauma, decreased morbidity, shorter hospital stays, and superior cosmetic results. Ten years after the first VATS resection of an ectopic mediastinal parathyroid, a robot-assisted thoracoscopic approach was described. Here we describe a series of five robot assisted complete thymectomies in patients with primary hyperparathyroidism due to mediastinal ectopic parathyroid adenomas. A single surgeon, single institution case series of five consecutive robotic-assisted mediastinal parathyroidectomies was performed between March 2013 and September 2015. The patients’ ages ranged from 31 to 65, 80 % were female, and all had primary hyperparathyroidism due to an ectopic parathyroid located in the lower mediastinum. Pre-operative imaging workup included Technetium 99-sestimibi parathyroid scan and CT scan of the chest. An ectopic parathyroid adenoma was successfully removed in all five cases, with intraoperative iOPTH decreasing ~50 % from baseline after 10 minutes. A hypercellular parathyroid was confirmed on pathologic exam in all specimens. Post-operative discharge and follow up calcium levels all returned to normal. There were no intraoperative complications, including no recurrent laryngeal nerve injuries, no postoperative morbidity, and no mortalities. This case series demonstrates that a robot-assisted complete thymectomy for mediastinal parathyroid adenomas causing primary hyperparathyroidism provides excellent visualization of the mediastinum, is effective at reducing PTH and calcium levels, and is safe with no morbidity or mortality.
Similar content being viewed by others
References
Phitayakorn R, McHenry CR (2006) Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 191(3):418–423
Conn JM et al (1991) The mediastinal parathyroid. Am Surg 57(1):62–66
Russell CF et al (1981) Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal. Ann Surg 193(6):805–809
Kumar A et al (2002) Thoracoscopy: the preferred method for excision of mediastinal parathyroids. Surg Laparosc Endosc Percutan Tech 12(4):295–300
Medrano C et al (2000) Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 69(1):221–223
Wei B et al (2011) Optimizing the minimally invasive approach to mediastinal parathyroid adenomas. Ann Thorac Surg 92(3):1012–1017
Prinz RA et al (1994) Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 116(6):999–1004 (discussion 1004–5)
Profanter C et al (2004) Robot-assisted mediastinal parathyroidectomy. Surg Endosc 18(5):868–870
Rea F et al (2011) Single-institution experience on robot-assisted thoracoscopic operations for mediastinal diseases. Innovations (Phila) 6(5):316–322
Augustin F, Schmid T, Bodner J (2006) The robotic approach for mediastinal lesions. Int J Med Robot 2(3):262–270
Bodner J et al (2004) Mediastinal parathyroidectomy with the da Vinci robot: presentation of a new technique. J Thorac Cardiovasc Surg 127(6):1831–1832
Bodner J et al (2004) Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg 78(1):259–265 (discussion 265–6)
Brunaud L et al (2008) Da Vinci robot-assisted thoracoscopy for primary hyperparathyroidism: a new application in endocrine surgery. J Chir (Paris) 145(2):165–167
Chan AP et al (2010) Robot-assisted excision of ectopic mediastinal parathyroid adenoma. Asian Cardiovasc Thorac Ann 18(1):65–67
Harvey A et al (2011) Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 21(1):e24–e27
Ismail M et al (2010) Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. Br J Surg 97(3):337–343
Neumann DR et al (1995) Localization of mediastinal parathyroid adenoma in recurrent postoperative hyperparathyroidism with Tc-99 m sestamibi SPECT. Clin Nucl Med 20(2):175
Tanna N et al (2006) Da Vinci robot-assisted endocrine surgery: novel applications in otolaryngology. Otolaryngol Head Neck Surg 135(4):633–635
Timmerman GL et al (2008) Hyperparathyroidism: robotic-assisted thoracoscopic resection of a supernumary anterior mediastinal parathyroid tumor. J Laparoendosc Adv Surg Tech A 18(1):76–79
Yadav R et al (2010) Case of the season: ectopic parathyroid adenoma in the pericardium: a report of robotically assisted minimally invasive parathyroidectomy. Semin Roentgenol 45(1):53–56
Richards ML et al (2011) An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg 146(3):280–285
Balduyck B et al (2011) Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection. Eur J Cardiothorac Surg 39(4):543–548
Bodner J et al (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 25(5):844–851
Bodner J et al (2004) Thoracoscopic resection of mediastinal parathyroids: current status and future perspectives. Minim Invasive Ther Allied Technol 13(3):199–204
Van Dessel E et al (2011) Mediastinal parathyroidectomy with the da Vinci robot. Innovations (Phila) 6(4):262–264
Karagkounis G et al (2014) Robotic surgery for primary hyperparathyroidism. Surg Endosc 28(9):2702–2707
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest.
Funding
There were no sources of funding.
Ethical approval
This research did not involve animals.
Informed consent
Informed consent was obtained prior to surgery and all patient data was de-identified.
Rights and permissions
About this article
Cite this article
Ward, A.F., Lee, T., Ogilvie, J.B. et al. Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism. J Robotic Surg 11, 163–169 (2017). https://doi.org/10.1007/s11701-016-0637-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-016-0637-1