Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom.
Department of Otorhinolaryngology and Head & Neck Surgery, Stanford School of Medicine, Stanford, CA, USA.
Int J Surg. 2015 Mar;15:55-60. doi: 10.1016/j.ijsu.2015.01.019. Epub 2015 Jan 29.
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.
一个最佳证据主题是根据结构化方案编写的。提出的问题是，机器人甲状旁腺切除术（RP）是否是治疗原发性甲状旁腺功能亢进症（pHPT）的靶向开放性甲状旁腺切除术的可行且安全的替代方法。使用报告的搜索共确定了 36 篇论文，其中 5 篇代表了回答临床问题的最佳证据。作者、日期、期刊、研究类型、人群、主要观察指标和结果均列于表中。靶向甲状旁腺切除术是 pHPT 的联合金标准手术，其结果与双侧颈部探查相当。这导致了微创甲状旁腺切除术（MIP）技术在术前定位腺瘤的广泛应用。但没有一种技术被证明具有压倒性优势。RP 是最新的一种技术。RP 克服了传统内镜手术的局限性，同时通过将其隐藏在腋窝或锁骨下区域来避免颈部疤痕。本综述的证据表明，与靶向开放性甲状旁腺切除术（TOP）相比，RP 具有可行性，并具有更好的美容效果，且安全性相当。与每种手术技术一样，适当的患者选择至关重要。目前正在等待关于 RP 的长期数据，特别是考虑到与 TOP 和其他 MIP 技术相比，它的成本高且手术时间长。因此，对于那些即使最小和最美容的颈部疤痕也不是选择的患者，RP 提供了一种可行但昂贵的替代其他形式的 MIP 的选择。
