title: Is robotic parathyroidectomy a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism?
abstract: A best evidence topic was written according to a structured protocol. The question addressed was whether robotic parathyroidectomy (RP) is a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism (pHPT). A total of 36 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Targeted parathyroidectomy constitutes the co-gold-standard procedure for pHPT with results equivalent to bilateral cervical exploration. This has led to the proliferation of minimally invasive parathyroidectomy (MIP) techniques for pre-operatively localised adenomas. None has been shown to be overwhelmingly superior. RP constitutes the most recent addition. RP overcomes the limitations of conventional endoscopic surgery and simultaneously avoids a neck scar by concealing it in the axilla or infraclavicular area. The evidence from the present review shows that RP is feasible and leads to a superior cosmetic result compared to targeted open parathyroidectomy (TOP) with an equivalent safety profile. As with every surgical technique, appropriate patient selection is crucial. Long-term data are currently awaited on RP especially in view of its high cost and long operative time compared to TOP and other MIP techniques. Hence, RP offers a viable but costly alternative to other forms of MIP in patients where even the smallest and most cosmetic neck scar is not an option.
authors: Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom. Electronic address: g.garas@imperial.ac.uk.
authors: George
authors: G
authors: Garas
authors: Department of Otorhinolaryngology and Head & Neck Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: Floyd C
authors: FC
authors: Holsinger
authors: Department of Otorhinolaryngology and Head & Neck Surgery, Mayo Clinic, Jacksonville, FL, USA.
authors: David G
authors: DG
authors: Grant
authors: Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom.
authors: Thanos
authors: T
authors: Athanasiou
authors: Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom.
authors: Asit
authors: A
authors: Arora
authors: Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom.
authors: Neil
authors: N
authors: Tolley
mesh_terms: D000236:Adenoma / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Cosmesis; Evidence-based medicine; Follow-up; Parathyroid; Patient reported outcome measures; Robotic surgery