title: 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.
  
  
  METHODS
  Feasibility study.
  
  
  METHODS
  Tertiary referral center.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Tolley
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.forename: Ranju
authors.initials: R
authors.lastname: Dhawan
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cox
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone