Kandil Emad, Hadedeya Deena, Shalaby Mahmoud, Toraih Eman, Aparício David, Garstka Meghan, Munshi Ruhul, Elnahla Ahmed, Russell Jonathon O, Aidan Patrick
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Genetic Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Gland Surg. 2021 Mar;10(3):953-960. doi: 10.21037/gs-20-761.
There have been few reports of robotic-assisted transaxillary parathyroidectomy in the literature. We aim to report our experience with robotic-assisted transaxillary parathyroidectomy for primary hyperparathyroidism (PHPT) in the Western population.
A retrospective study was performed from July 2010 through July 2019 at two institutions, one in the United States and one in France. Demographic characteristics and perioperative data were collected for all patients undergoing robotic-assisted transaxillary parathyroidectomy by a single surgeon at each institution. A linear regression model was developed to describe the learning curve for this procedure at each institution.
One-hundred and two patients with PHPT were included with a median age of 55.6±12.4 years and median body mass index (BMI) of 25.5±6.1 kg/m. The majority of patients were female (80.4%). Median total operative time was 116±53 minutes. Minor complications were reported in 2 patients (1.96%), and one case was converted to a trans-cervical approach (TCA) for four-gland exploration. Median patient follow-up time was 6.5±12.2 months, and disease recurrence was reported in one patient. Calculated learning curves showed that one surgeon achieved proficiency by the eighth case, and the other achieved proficiency by the fourteenth case.
This is the largest reported experience of robotic-assisted transaxillary parathyroidectomy for PHPT in the Asian and Western population. Analysis of the procedural learning curve demonstrates that proficiency in this technique was achieved after performance of less than 15 surgeries. This procedure is safe and feasible in the hands of experienced surgeons for select patients with localized disease.
文献中关于机器人辅助经腋窝甲状旁腺切除术的报道较少。我们旨在报告我们在西方人群中进行机器人辅助经腋窝甲状旁腺切除术治疗原发性甲状旁腺功能亢进症（PHPT）的经验。
2010年7月至2019年7月在两个机构进行了一项回顾性研究，一个在美国，一个在法国。收集了每个机构由一名外科医生为所有接受机器人辅助经腋窝甲状旁腺切除术的患者的人口统计学特征和围手术期数据。建立了线性回归模型来描述每个机构该手术的学习曲线。
纳入了102例PHPT患者，中位年龄为55.6±12.4岁，中位体重指数（BMI）为25.5±6.1kg/m²。大多数患者为女性（80.4%）。中位总手术时间为116±53分钟。2例患者（1.96%）报告有轻微并发症，1例转为经颈入路（TCA）进行四腺探查。患者中位随访时间为6.5±12.2个月，1例患者报告疾病复发。计算得出的学习曲线显示，一名外科医生在第8例手术时达到熟练水平，另一名在第14例手术时达到熟练水平。
这是亚洲和西方人群中关于机器人辅助经腋窝甲状旁腺切除术治疗PHPT的最大规模报道经验。对手术学习曲线的分析表明，在进行少于15例手术后就达到了该技术的熟练水平。对于有经验的外科医生来说，该手术对于选定的局限性疾病患者是安全可行的。
