Robotic Resection of an Ectopic Parathyroid Gland: A Systematic Review

Abstract

Ectopic parathyroid glands result from abnormal migration during development. If not detected promptly, they can lead to persistent or recurrent primary hyperparathyroidism (pHPT). Inferior parathyroid glands are typically located in the anterior mediastinum, while superior parathyroid glands are often near the tracheoesophageal groove, both of which contribute to pHPT. Surgical management of pHPT often involves advanced techniques, with robotic parathyroidectomy using the da Vinci system emerging as an effective approach. This method offers comparable outcomes to traditional surgery, along with enhanced cosmetic results. This systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and an author-approved protocol to compare success rates, outcomes, and complications associated with robotic parathyroidectomy specifically for ectopic parathyroid glands. The authors conducted a thorough search of PubMed and Google Scholar using Medical Subject Headings (MeSH) terms such as "Robotic resection surgical techniques," "Endocrine surgery," and "Ectopic parathyroid gland." After screening 200 papers, seven studies were selected based on relevance and methodological rigour. Each study's quality and risk of bias were assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool for non-randomised studies, and findings were visualised using the Risk of Bias Visualisation (ROBVIS) tool to ensure systematic evaluation of potential biases, such as confounding and selection. This review addresses a gap in the literature by focusing on robotic-assisted surgery for ectopic parathyroid glands, highlighting its advantages, including enhanced visualisation and reduced surgical trauma in challenging anatomical sites. These benefits result in shorter hospital stays, fewer perioperative complications, and improved cosmetic outcomes. However, the broader adoption of robotic surgery requires significant investment in training and equipment, and careful patient selection is essential to minimise complications such as brachial plexus injury. Robotic parathyroidectomy demonstrates favourable patient outcomes in comparison to traditional methods, particularly for difficult-to-access ectopic glands. However, ongoing research is needed to further optimise surgical efficacy, especially through the integration of histopathological and intraoperative monitoring. Future randomised controlled trials (RCTs) should focus on long-term outcomes, cost-effectiveness, and comparing robotic surgery to traditional methods in terms of both clinical success and patient quality of life.

Keywords: da vinci robotic system; ectopic parathyroid glands; primary hyperparathyroidism; robotic parathyroidectomy; systematic review.

Figure 1. PRISMA flow diagram demonstrating the literature selection strategy.

Image credit: [11] PRISMA, Preferred reporting items for systematic reviews and meta-analyses

Figure 2. This graph shows the risk of bias for each study in our review using the ROBINS-I tool.

Image credit: [23] ROBINS-I, Risk of bias in non-randomised studies of interventions