Ann Surg Treat Res.  2024 Apr;106(4):203-210. 10.4174/astr.2024.106.4.203.

Outcomes of bilateral axillo-breast approach robotic parathyroidectomy versus open parathyroidectomy for primary hyperparathyroidism: a single-institution retrospective study

• Choi JB
• Choi JH
• Kong Y
• Lee JK
• Kim W
• Yu HW
• Kim Sj
• Chai YJ
• Choi JY
• Lee KE

• KMID: 2554479
• DOI: http://doi.org/10.4174/astr.2024.106.4.203

Abstract

Purpose
Bilateral axillo-breast approach robotic parathyroidectomy (BABA-RP) aims to remove overactive or enlarged parathyroid glands with no visible neck collar incision. In this study, we compared the safety and surgical outcomes of BABA-RP vs. those of an open surgery group to ascertain whether BABA-RP is a safe and feasible surgical approach for patients with primary hyperparathyroidism (pHPT).
Methods
This single-institution retrospective cohort study included 74 patients with primary HPT who underwent open parathyroidectomy (n = 37) or BABA-RP (n = 37) at our institution between November 2014 and March 2023. Patient demographics, biochemical cure rates, operative time, blood loss rates, and complication rates were examined and compared.
Results
The patients in the BABA-RP group were younger and had a longer mean operative time. Regarding complication events, 2 patients in the open surgery group and 1 patient in the BABA-RP group had transient hypoparathyroidism. All 74 patients achieved biochemical cure at <6 months, regardless of the approach used. Two patients in the BABA-RP group and 1 patient in the open surgery group had carcinoma on surgical pathology. All 3 patients with parathyroid carcinoma remained recurrence-free at 1-year follow-up.
Conclusion
Compared with the open procedure, BABA-RP is a safe and feasible procedure that provides an excellent biochemical cure rate for patients with pHPT and has superior cosmetic benefits with equivalent surgical outcomes.

Keyword

Parathyroidectomy; Primary hyperparathyroidism; Robotic surgical procedures

Figure

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  Fig. 1 Preoperative imaging studies of parathyroid tumor localization . Commonly used imaging modalities for localizing parathyroid tumors. (A) Sonographic findings of the left parathyroid tumor (arrow). (B) Parathyroid 4-dimensional CT of the left parathyroid tumor (arrow). (C) Technetium-99m sestamibi scan of the left parathyroid tumor (arrow). (D) Single photon emission CT image after technetium-99m sestamibi injection into the left parathyroid tumor (arrow).

• 

  Fig. 2 Flap dissection area and trocar insertion sites of bilateral axillo-breast approach robotic parathyroidectomy. Two 8-mm ports were inserted through bilateral circumareolar incisions for the videoscope and electrocautery hook (or harmonic scalpel). Two 8-mm ports were inserted through the bilateral axillary incision for the Maryland Bipolar and Prograsp. Flap dissection around the sternocleidomastoid and anterior neck provided a working space.

• 

  Fig. 3 Bilateral axillo-breast approach (BABA) robotic view of bilateral parathyroid tumor during BABA robotic parathyroidectomy. (A) BABA robotic view of the right parathyroid tumor (arrow). Asterisk, right thyroid gland. (B) BABA robotic view of the left parathyroid tumor (arrow). Asterisk, left thyroid gland. H, head direction; CCA, right common carotid artery; T, trachea; S, strap muscle.

• 

  Fig. 4 Biochemical remission trend of the bilateral axillo-breast approach robotic parathyroidectomy (BABA-RP) and open parathyroidectomy groups during the 6-month follow-up. All patients in the BABA-RP (n = 37) and open surgery (n = 37) groups achieved biochemical remission at 1 month of follow-up, and no recurrence occurred during the 6-month follow-up. (A) Serum parathyroid hormone (PTH) level (normal range of serum PTH, 15–65 pg/mL). (B) Serum calcium level (normal range of serum calcium, 8.8–10.5 mg/dL).

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