title: Robotic total parathyroidectomy by the axillo-bilateral-breast approach for secondary hyperparathyroidism: a feasibility study.
abstract: BACKGROUND
  The aim of this study was to evaluate the clinical application and superiority of the da Vinci(®) Si Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in total parathyroidectomy for secondary hyperparathyroidism.
  
  
  METHODS
  Total parathyroidectomy was performed with the da Vinci Si Surgical System by the four-trocar axillo-bilateral-breast approach. The patients were placed in the supine position, and the operation procedure included creating the workspace, docking, and consoling stages. The camera arm is centered in the working space. Three working arms are then placed adjacent to the camera. The Harmonic(®) scalpel (Ethicon Endo-surgery, Inc., Cincinnati, OH) was used for hemostasis and gland resection, and dissected parathyroid was taken out by a specimen pouch.
  
  
  RESULTS
  Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation in 6 patients was successfully performed with the da Vinci Si Surgical System. There were no operation-related complications and no conversions to open or endoscopic surgery. Mean operation time was 156 minutes. Patients were discharged from the hospital 6 days after surgery. The postoperative cosmetic result was satisfactory, with minimal numbness and tingling on the anterior chest.
  
  
  CONCLUSIONS
  This initial study shows that robotic total parathyroidectomy via the axillo-bilateral-breast approach is a safe and feasible alternative to selected patients, especially those with esthetic concerns.
authors.affiliation: Department of Thyroid & Parathyroid Surgery, Jinan Military General Hospital of PLA , Jinan, The People's Republic of China .
authors.forename: Qingqing
authors.initials: Q
authors.lastname: He
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.forename: Dayong
authors.initials: D
authors.lastname: Zhuang
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000328:Adult; D001365:Axilla; D001940:Breast; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016105:Parathyroidectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome