Brunaud Laurent, Li Zhen, Van Den Heede Klaas, Cuny Thomas, Van Slycke Sam
1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France.
Gland Surg. 2016 Jun;5(3):352-60. doi: 10.21037/gs.2016.01.06.
Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations.
原发性甲状旁腺功能亢进症（PHPT）是最常见的内分泌疾病之一，甲状旁腺切除术是其最有效的治疗方法。直到20世纪70年代末，甲状旁腺切除术的标准方法是通过一个大的皮肤切口进行四腺探查。然而，80%至85%的PHPT病例是由单个腺瘤引起的。因此，有人认为为了可视化所有四个腺体而进行双侧探查的概念是过度的，因为在大多数情况下，只有一个异常腺体。聚焦探查（一个腺体）目前是全球甲状旁腺切除术的标准技术。尽管大多数内分泌外科中心迅速接受了微创方法，但使用或不使用机器人系统的内窥镜进行甲状旁腺切除术仍存在争议。本研究的目的是回顾目前关于在PHPT患者管理中使用或不使用机器人系统的内窥镜手术方法的现有数据。对于传统的内窥镜和视频辅助甲状旁腺切除术，几项比较研究表明，与开放非内窥镜微创甲状旁腺切除术相比，在减轻术后疼痛、改善美容效果和提高患者满意度方面具有一些优势。机器人辅助经腋窝甲状旁腺切除术的优点是颈部不留疤痕，但鉴于已发表系列的数量有限，其作用尚未明确界定。通过将疤痕隐藏在腋窝或锁骨下区域，术后主观美容评价良好。然而，与传统的开放或内窥镜颈部入路手术相比，这种方法需要更广泛的解剖。真正的异位纵隔甲状旁腺患者是传统或机器人辅助胸腔镜手术的良好候选者，因为这些腺体位于偏远和狭窄的解剖位置。
