Department of Otorhinolaryngology and Head & Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Otolaryngol Head Neck Surg. 2011 Jun;144(6):859-66. doi: 10.1177/0194599811402152. Epub 2011 May 5.
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.
Feasibility study.
Tertiary referral center.
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).
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.
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.
甲状旁腺切除术是局部甲状旁腺疾病的金标准。机器人辅助方法尚未得到研究。目的是评估一种避免颈部疤痕的机器人技术的可行性。
可行性研究。
三级转诊中心。
前瞻性评估了 11 例原发性甲状旁腺功能亢进症患者。三重模态一致定位是先决条件。所有患者均接受机器人辅助甲状旁腺切除术（RAP）。评估的结果变量包括手术时间、声音变化、生化治愈率和组织病理学确认。患者报告的结果测量（PROMs）包括疼痛和疤痕美容的主观评估、语音障碍指数 2 和 EQ-5D 生活质量评估。平均随访时间为 6 个月（范围 3-12 个月）。
所有病例均成功切除甲状旁腺腺瘤，出血量极少（<5 mL）。有 1 例转为开放手术。无声音改变。机器人对接时间在 8 例后稳定在 10 分钟。平均暴露时间和控制台时间（分别为 31 分钟和 51 分钟）受体型影响。术后第 1 天疤痕美容的平均视觉模拟评分（VAS）为 75%，6 个月时提高到 92%，1 年时提高到 95%。疼痛评分在 2 周时下降至 8%。手术后所有 5 个 EQ-5D 生活质量参数均显著改善。
机器人方法对于进行避免颈部疤痕的靶向甲状旁腺切除术是可行的。与传统的靶向甲状旁腺切除术相比，机器人方法的临床疗效和成本效益需要进一步评估，以确定它是否是现有靶向技术的可行替代方案。
