title: Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism.
abstract: One to two percent of ectopic parathyroid adenomas are found in the lower mediastinum and often these are best accessed via a sternotomy or thoracotomy. Video-assisted thoracoscopic surgery (VATS) is an alternative approach with less surgical trauma, decreased morbidity, shorter hospital stays, and superior cosmetic results. Ten years after the first VATS resection of an ectopic mediastinal parathyroid, a robot-assisted thoracoscopic approach was described. Here we describe a series of five robot assisted complete thymectomies in patients with primary hyperparathyroidism due to mediastinal ectopic parathyroid adenomas. A single surgeon, single institution case series of five consecutive robotic-assisted mediastinal parathyroidectomies was performed between March 2013 and September 2015. The patients' ages ranged from 31 to 65, 80 % were female, and all had primary hyperparathyroidism due to an ectopic parathyroid located in the lower mediastinum. Pre-operative imaging workup included Technetium 99-sestimibi parathyroid scan and CT scan of the chest. An ectopic parathyroid adenoma was successfully removed in all five cases, with intraoperative iOPTH decreasing ~50 % from baseline after 10 minutes. A hypercellular parathyroid was confirmed on pathologic exam in all specimens. Post-operative discharge and follow up calcium levels all returned to normal. There were no intraoperative complications, including no recurrent laryngeal nerve injuries, no postoperative morbidity, and no mortalities. This case series demonstrates that a robot-assisted complete thymectomy for mediastinal parathyroid adenomas causing primary hyperparathyroidism provides excellent visualization of the mediastinum, is effective at reducing PTH and calcium levels, and is safe with no morbidity or mortality.
authors: Division of Thoracic Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 9V, New York, NY, 10016, USA.
authors: Alison F
authors: AF
authors: Ward
authors: Division of Thoracic Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 9V, New York, NY, 10016, USA.
authors: Timothy
authors: T
authors: Lee
authors: Division of Endocrine Surgery, NYU Langone Medical Center, 560 1st Avenue, New York, NY, 10016, USA.
authors: Jennifer B
authors: JB
authors: Ogilvie
authors: Division of Endocrine Surgery, NYU Langone Medical Center, 560 1st Avenue, New York, NY, 10016, USA.
authors: Kepal N
authors: KN
authors: Patel
authors: Division of Endocrine Surgery, NYU Langone Medical Center, 560 1st Avenue, New York, NY, 10016, USA.
authors: Karen
authors: K
authors: Hiotis
authors: Division of Thoracic Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 9V, New York, NY, 10016, USA.
authors: Costas
authors: C
authors: Bizekis
authors: Division of Thoracic Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 9V, New York, NY, 10016, USA. Michael.Zervos@nyumc.org.
authors: Michael
authors: M
authors: Zervos
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002828:Choristoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008477:Mediastinal Diseases / Q000601:surgery*; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D013934:Thymectomy / Q000379:methods*
keywords: Mediastinal tumor; Mediastinum; Robotics; Thymectomy