Robotic Parathyroid Surgery: Current Perspectives and Future Considerations

被引:16
作者
Arora, Asit [1 ]
Garas, George [2 ,3 ]
Tolley, Neil [2 ]
机构
[1] Guys & St Thomas NHS Fdn Trust, Dept Otorhinolaryngol & Head & Neck Surg, London, England
[2] Imperial Coll Healthcare NHS Trust, St Marys Hosp, Dept Otorhinolaryngol & Head & Neck Surg, London, England
[3] Royal Coll Surgeons England, Dept Surg Res & Innovat, London, England
来源
ORL-JOURNAL FOR OTO-RHINO-LARYNGOLOGY HEAD AND NECK SURGERY | 2018年 / 80卷 / 3-4期
关键词
Robotic surgery; Parathyroid; Axillary approach; Evidence; Safety; Cosmesis; Policy; SURGICAL-MANAGEMENT; THYROID-SURGERY; TRANSAXILLARY; EXCISION; ADENOMA;
D O I
10.1159/000488355
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Robotic parathyroidectomy represents a novel surgical approach in the treatment of primary hyperparathyroidism when the parathyroid adenoma has been pre-operatively localised. It represents the fourth generation in the evolution of parathyroid surgery following a process of surgical evolution from cervicotomy and 4-gland exploration to a variety of minimally invasive, open and endoscopic, targeted approaches. The existing evidence (levels 2-3) supports it as a feasible and safe technique with equivalent results to targeted open parathyroidectomy for primary hyperparathyroidism in carefully selected patients. However, it takes longer to perform and is more costly than conventional parathyroidectomy. It offers superior cosmesis by completely avoiding a neck scar making it a valid option for those patients who for biological and/or cultural reasons may wish to avoid a neck scar. Robotic parathyroidectomy is not for every patient, surgeon, or hospital. Its application should be confined to high-volume centres and experienced surgeons. Intensive training and proctorship are required for its safe implementation combined with careful patient selection. This particularly relates to the patient's body habitus (BMI < 30 kg/m(2)) and concordance among the different imaging modalities used pre-operatively. With robotic market competition driving down costs, its role may change. For now, robotic parathyroidectomy occupies a niche role and can only be justified in a select subset of patients.
引用
收藏
页码:195 / 203
页数:9
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