Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 542-547
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.542
Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature
Yasar Ozdenkaya, Cenk Ersavas, Naciye Cigdem Arslan
Yasar Ozdenkaya, Cenk Ersavas, Naciye Cigdem Arslan, Department of General Surgery, Medipol University, Istanbul 34214, Turkey
Author contributions: Ozdenkaya Y and Arslan NC designed the report; Ozdenkaya Y and Ersavas C collected the patients’ clinical data; Ozdenkaya Y and Arslan NC analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest or funding received for this work.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yasar Ozdenkaya, MD, Assistant Professor, Surgeon, Department of General Surgery, Medipol University, Goztepe Mah, Metin Sk. 4, Istanbul 34214, Turkey. yozdenkaya@yahoo.com
Telephone: +90-533-2516339 Fax: +90-212-4607162
Received: July 31, 2018
Peer-review started: July 31, 2018
First decision: August 20, 2018
Revised: August 27, 2018
Accepted: August 28, 2018
Article in press: August 30, 2018
Published online: October 26, 2018
Abstract

Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.

Keywords: Transoral vestibular surgery, Parathyroid adenoma, Natural orifice transendoluminal surgery, Robotics, Parathyroidectomy

Core tip: In this paper we present the first national transoral parathyroidectomy cases and to our knowledge, these are the first transoral vestibular robotic parathyroidectomy cases without thyroidectomy. Our results indicate that correct preoperative localization and experience is essential for success in minimally invasive parathyroidectomy.