Trans-subxiphoid robotic surgery for the excision of an ectopic mediastinal parathyroid gland: A technical note with video vignette

摘要

Ectopic mediastinal parathyroid glands are typically accessible for removal through a cervical incision. However, when the cervical approach is impractical, alternative methods, including the trans-thoracic or trans-sternal routes, are frequently considered. This report introduces a pioneering, robot-assisted trans-subxiphoid technique. This method was adeptly applied to a 67-year-old man with secondary hyperparathyroidism unresponsive to medical therapy, resulting from chronic renal failure. The patient underwent a robotic surgical procedure for the removal of an ectopic mediastinal parathyroid gland via the trans-subxiphoid route. This study details the surgical process and is supplemented with a video vignette to enhance conceptualization. A 3-cm longitudinal incision was executed below the xiphoid process. The anterior mediastinum was accessed through an opening created beneath the sternum, followed by the establishment of a retrosternal tunnel via blunt finger dissection, facilitating entry into the pleural cavity. Subsequently, two symmetrical 1-cm incisions were made along the anterior axillary line at the sixth intercostal space. Through these incisions, two 8-mm trocars were carefully inserted, allowing for the seamless docking of the surgical robot. The ectopic gland was excised en bloc with the thymus. The operation was efficiently completed in 117 min, devoid of any significant intraoperative complications. The patient's recovery was swift, allowing for discharge on the second postoperative day. Immediate biochemical remission was observed, with sustained favorable outcomes at the 12-month follow-up. The trans-subxiphoid approach offers a viable alternative to trans-thoracic or trans-sternal routes for ectopic mediastinal parathyroid gland resection when cervical access is impractical.