Robotic Transaxillary Parathyroidectomy for Upper Mediastinal Parathyroid Adenoma: A Case Report

Background: Gold standard treatment for Primary hyperparathyroidism (PHPT) is surgical resection of the adenoma, which in nearly 22-25% of the cases is ectopic. The evolution of preoperative imaging techniques, in association with the intraoperative PTH measurement (IOPTH) have led to the development of minimally invasive targeted approaches for the management of PHPT. We hereby report a case of a mediastinal parathyroid adenoma removed using the robotic-assisted transaxillary approach Case presentation: A 46-year-old female presented with PHPT caused by a parathyroid ectopic adenoma located in the upper mediastinum, adjacent to the left sternal notch. We performed a robotic transaxillary parathyroidectomy, with IOPTH measurement. Total operative time was 97 minutes, with no complications. The patient was discharged the next day. At one month follow up total serum calcium was between normal ranges Discussion: The Robotic transaxillary approach for parathyroid adenoma has been recently described in literature providing promising results. This procedure completely avoids a scar in a visible area such as the neck and can be performed without the need for gas insufflation. This procedure is particularly recommended in selected patients with history of keloid or hypertrophic scar formation or deeply concerned about the cosmetic outcomes. Robotic-assisted surgery allows fine dissection with better control of the instruments even in narrow spaces Conclusion: The role of the transaxillary approach in ectopic mediastinal parathyroid adenoma is still under evaluation, but in our opinion, it represents a valid option in case of a well localized single adenoma in the upper mediastinum.