Robotic-assisted parathyroidectomy: a feasibility study.

Abstract

OBJECTIVE:

Targeted parathyroidectomy is the gold standard for localized parathyroid disease. A robotic-assisted approach has not been investigated. The aim was to assess the feasibility of a robotic technique that avoids a neck scar.

STUDY DESIGN:

Feasibility study.

SETTING:

Tertiary referral center.

SUBJECTS AND METHODS:

Eleven patients with primary hyperparathyroidism were prospectively evaluated. Triple modality concordant localization was a prerequisite. All patients underwent robotic-assisted parathyroidectomy (RAP). Outcome variables assessed were operative time, voice change, biochemical cure, and histopathological confirmation. Patient-reported outcome measures (PROMs) included subjective assessment of pain and scar cosmesis, Voice Handicap Index 2, and EQ-5D quality-of-life assessment. Mean follow-up was 6 months (range, 3-12 months).

RESULTS:

The parathyroid adenoma was successfully excised in all cases with negligible blood loss (<5 mL). There was 1 conversion. There was no voice change in any case. Robot docking time plateaued to 10 minutes after 8 cases. Mean exposure and console times (31 and 51 minutes, respectively) were affected by body habitus. The mean visual analog scale for scar cosmesis was 75% on the first postoperative day, improving to 92% at 6 months and 95% at 1 year. Pain scores decreased to 8% at 2 weeks. All 5 EQ-5D quality-of-life parameters significantly improved following surgery.

CONCLUSION:

The robotic approach is feasible for performing targeted parathyroidectomy that avoids a neck scar. The clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted parathyroidectomy warrant further evaluation to establish if this represents a viable alternative to the existing targeted techniques.

• Authors: Neil Tolley, Asit Arora, Fausto Palazzo, George Garas, Ranju Dhawan, Jeremy Cox, Ara Darzi
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 144 Issue 6 Pg. 859-66 (Jun 2011) ISSN: 1097-6817 [Electronic] England
• PMID: 21546590 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Parathyroid Hormone

Topics

• Aged
• Equipment Design
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Hyperparathyroidism, Primary (blood, diagnosis, surgery)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Parathyroid Neoplasms (blood, diagnosis, surgery)
• Parathyroidectomy (methods)
• Pilot Projects
• Prospective Studies
• Robotics (instrumentation)
• Tomography, Emission-Computed, Single-Photon
• Treatment Outcome