Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Oct;4(5):420-8.
doi: 10.3978/j.issn.2227-684X.2015.04.09.

Robotic transaxillary and retroauricular parathyroid surgery

Hossam Eldin Mohamed  1 , Parisha Bhatia  1 , Rizwan Aslam  1 , Thomas Moulthrop  1 , Emad Kandil  1
Affiliations
Review

Robotic transaxillary and retroauricular parathyroid surgery

Hossam Eldin Mohamed et al. Gland Surg. 2015 Oct.

Abstract

Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.

Keywords: Robotic-assisted; parathyroidectomy; remote access; retroauricular; transaxillary.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Transverse ultrasound of the neck shows a right inferior parathyroid adenoma. The lesion demonstrates a hypoechoic, well defined, oval shaped, homogenous shape, which is characteristic of a parathyroid adenoma. T, thyroid; CA, carotid artery; PA, parathyroid adenoma.
Figure 2
Figure 2
Patient is positioned supine under general anesthesia and intubated with an NIM endotracheal tube. NIM, Nerve Integrity Monitor.
Figure 3
Figure 3
Ulnar and median nerves are routinely monitored using somatosensory evoked potentials (SSEP).
Figure 4
Figure 4
Landmarks for the robotic trans-axillary incisions.
Figure 5
Figure 5
Subcutaneous plane is developed superficial to the pectoralis major muscle fascia and the heads of the SCM are identified (The plane can be developed using electrocautery or ultrasonic Harmonic scalpel). SCM, sternocleidomastoid.
Figure 6
Figure 6
Identification of the recurrent laryngeal nerve in the tracheosophageal groove.
Figure 7
Figure 7
Closure of the skin at the hairline with interrupted 5-0 Prolene sutures and staples.
See this image and copyright information in PMC

References

    1. Noureldine SI, Lewing N, Tufano RP, et al. The role of the robotic-assisted transaxillary gasless approach for the removal of parathyroid adenomas. ORL J Otorhinolaryngol Relat Spec 2014;76:19-24. - PubMed
    1. Katz L, Abdel Khalek M, Crawford B, et al. Robotic-assisted transaxillary parathyroidectomy of an atypical adenoma. Minim Invasive Ther Allied Technol 2012;21:201-5. - PubMed
    1. Landry CS, Grubbs EG, Morris GS, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 2011;149:549-55. - PubMed
    1. Foley CS, Agcaoglu O, Siperstein AE, et al. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc 2012;26:2259-66. - PubMed
    1. Mohamed SE, Li X, Khadra H, et al. Different surgical approaches in parathyroid adenoma resections. Gland Surg 2013;2:227-9. - PMC - PubMed