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Mediastinal Parathyroidectomy with the da Vinci Robot

Van Dessel, Els MD; Hendriks, Jeroen M. H. MD, PhD; Lauwers, Patrick MD; Ysebaert, Dirk MD, PhD; Ruyssers, Natacha Jr MD; Van Schil, Paul E. Y. MD, PhD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: July-August 2011 - Volume 6 - Issue 4 - p 262-264
doi: 10.1097/IMI.0b013e31822c5a4a
Case Report

Mediastinal parathyroid glands are often located in a position which is inaccessible through a cervical approach. Because of the significant morbidity of open surgery, the need for minimal invasive approaches is high. More recently, robotic systems have been introduced to refine the dissection and optimize the view in the mediastinal region. We present two cases. The first case is a 34-year-old woman who was diagnosed with primary hyperparathyroidism. Because a bilateral neck dissection disclosed no parathyroid adenoma, we performed a parathyroid sestamibi scan and computed tomographic scan of neck and mediastinum to look for aberrant parathyroid glands. Both showed a parathyroid adenoma in the mediastinum on the left side. The second case is a 66-year-old man. A sestamibi scan showed a parathyroid adenoma of 3 cm in the superior mediastinum which was confirmed by and computed tomographic scan. In both cases, we performed a parathyroidectomy with the da Vinci robotic system through a left-sided approach. Three thoracoports were inserted around the mammary gland for the robot and a fourth auxiliary port was positioned in between. Single-lung ventilation was installed, and the mediastinum was entered by opening the parietal pleura along the left phrenic nerve. The upper margin for dissection was the left brachiocephalic vein that was followed until the right pleura. All the tissue in front of the pericardium was dissected en bloc. The sinking test of the nodule and a preoperative frozen section analysis confirmed the diagnosis of parathyroid adenoma, which was also proven by rapid parathyroid hormone analysis. The resection of a parathyroid adenoma from the aortopulmonary window represents an ideal case for robotic surgery.

From the *Departments of Thoracic and Vascular Surgery and †Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.

Accepted for publication June 30, 2011.

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Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 16–19, 2010, Berlin, Germany.

Disclosure: The authors declare no conflict of interest.

Address correspondence and reprint requests to Els Van Dessel, MD, Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Misstraat 162, Lier, 2500 Antwerpen, Belgium. E-mail: vandesselels@msn.com.

©2011 by the International Society for Minimally Invasive Cardiothoracic Surgery