Scoping review of approaches used for remote-access parathyroidectomy: A contemporary review of techniques, tools, pros and cons
Corresponding Author
Yoshiyuki Saito MD, PhD
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Department of Surgery, Keio University School of Medicine, Tokyo, Japan
Correspondence
Yoshiyuki Saito, Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Email: [email protected]
Search for more papers by this authorYoshifumi Ikeda MD, PhD
Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
Search for more papers by this authorHiroshi Takami MD, PhD
Department of Surgery, Ito Hospital, Tokyo, Japan
Search for more papers by this authorAmr H. Abdelhamid Ahmed MBBCH, MMSc
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAtsushi Nakao MD
Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
Search for more papers by this authorHiroshi Katoh MD, PhD
Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Search for more papers by this authorKeiso Ho MD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorMasato Tomita MD, PhD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorMichio Sato MD, PhD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorNeil S. Tolley MD
Imperial College Healthcare NHS Trust, London, UK
Search for more papers by this authorGregory W. Randolph MD
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorCorresponding Author
Yoshiyuki Saito MD, PhD
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Department of Surgery, Keio University School of Medicine, Tokyo, Japan
Correspondence
Yoshiyuki Saito, Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Email: [email protected]
Search for more papers by this authorYoshifumi Ikeda MD, PhD
Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
Search for more papers by this authorHiroshi Takami MD, PhD
Department of Surgery, Ito Hospital, Tokyo, Japan
Search for more papers by this authorAmr H. Abdelhamid Ahmed MBBCH, MMSc
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAtsushi Nakao MD
Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
Search for more papers by this authorHiroshi Katoh MD, PhD
Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Search for more papers by this authorKeiso Ho MD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorMasato Tomita MD, PhD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorMichio Sato MD, PhD
Department of Surgery, International Goodwill Hospital, Yokohama, Japan
Search for more papers by this authorNeil S. Tolley MD
Imperial College Healthcare NHS Trust, London, UK
Search for more papers by this authorGregory W. Randolph MD
Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAbstract
After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Open Research
DATA AVAILABILITY STATEMENT
Data are available on request from the authors.
REFERENCES
- 1Ikeda Y, Takami H. Endoscopic parathyroidectomy. Biomed Pharmacother. 2000; 54(Suppl 1): 52s-56s.
- 2Arora A, Garas G, Tolley N. Robotic parathyroid surgery: current perspectives and future considerations. ORL J Otorhinolaryngol Relat Spec. 2018; 80(3–4): 195-203.
- 3Richmon JD. Lateral vestibular approach to the central neck for thyroid and parathyroid surgery: a cadaveric study. J Laparoendosc Adv Surg. 2020; 31: 579-583.
- 4Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097.
- 5Berber E, Bernet V, Fahey TJ 3rd, et al. American Thyroid Association statement on remote-access thyroid surgery. Thyroid. 2016; 26(3): 331-337.
- 6Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9): 712-716.
- 7Vu-Ngoc H, Elawady SS, Mehyar GM, et al. Quality of flow diagram in systematic review and/or meta-analysis. PloS One. 2018; 13(6):e0195955.
- 8Kurganov IA, Emelyanov SI, Bogdanov DY, et al. Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study). Khirurgiia. 2017; 11: 32-36.
- 9Ozdenkaya Y, Ersavas C, Arslan NC. Robotic transoral vestibular parathyroidectomy: two case reports and review of literature. World J Clin Cases. 2018; 6(12): 542-547.
- 10Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg. 2000; 191(3): 336-340.
- 11Takami H, Ikeda Y, Wada N. Surgical management of primary hyperparathyroidixsm. Biomed Pharmacother. 2000; 54(Suppl 1): 17s-20s.
- 12Saito Y, Ikeda Y, Katoh H, Nakao A, Takami H. Is total endoscopic parathyroidectomy an acceptable treatment for patients with primary hyperparathyroidism due to a presumed solitary adenoma?—comparison of minimally invasive total endoscopic parathyroidectomy and open minimally invasive parathyroidectomy. Gland Surgery. 2020; 10: 83-89.
- 13Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J. Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report. Surg Endosc. 2002; 16(1): 92-95.
- 14Takami H, Ikeda Y, Kan S, Kameyama K. New operative strategies in primary hyperparathyroidism. Asian J Surg. 2002; 25(2): 184-187.
- 15Dutta S, Slater B, Butler M, Albanese CT. “Stealth surgery”: transaxillary subcutaneous endoscopic excision of benign neck lesions. J Pediatr Surg. 2008; 43(11): 2070-2074.
- 16Lobe TE, Wright SK. The transaxillary, totally endoscopic approach for head and neck endocrine surgery in children. J Laparoendosc Adv Surg Tech A. 2011; 21(1): 97-100.
- 17Sackett WR, Barraclough B, Reeve TS, Delbridge LW. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg (Chicago, Ill: 1960). 2002; 137(9): 1055-1059.
- 18Landry CS, Grubbs EG, Morris GS, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery. 2011; 149(4): 549-555.
- 19Mohamed SE, Li X, Khadra H, Saeed A, Mohamed H, Kandil E. Different surgical approaches in parathyroid adenoma resections. Gland Surg. 2013; 2(4): 227-229.
- 20Karagkounis G, Uzun DD, Mason DP, Murthy SC, Berber E. Robotic surgery for primary hyperparathyroidism. Surg Endosc. 2014; 28(9): 2702-2707.
- 21Noureldine SI, Lewing N, Tufano RP, Kandil E. The role of the robotic-assisted transaxillary gasless approach for the removal of parathyroid adenomas. ORL J Otorhinolaryngol Relat Spec. 2014; 76(1): 19-24.
- 22Mohamed HE, Bhatia P, Aslam R, Moulthrop T, Kandil E. Robotic transaxillary and retroauricular parathyroid surgery. Gland Surg. 2015; 4(5): 420-428.
- 23Okoh AK, Sound S, Berber E. Robotic parathyroidectomy. J Surg Oncol. 2015; 112(3): 240-242.
- 24Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012; 26(8): 2259-2266.
- 25Wu EL, Garstka ME, Kang SW, Kandil E. Robotic neck surgery in the pediatric population. J Soc Laparoendosc Surg. 2018; 22(3):e2018.00012.
- 26Lee JA, Inabnet WB 3rd. The surgeon's armamentarium to the surgical treatment of primary hyperparathyroidism. J Surg Oncol. 2005; 89(3): 130-135.
- 27Kandil E, Attia AS, Hadedeya D, Shihabi A, Elnahla A. Robotic thyroidectomy: past, future, and current perspectives. Otolaryngol Clin North Am. 2020; 53(6): 1031-1039.
- 28Ikeda Y, Takami H, Tajima G, et al. Total endoscopic parathyroidectomy. Biomed Pharmacother. 2002; 56(Suppl 1): 22s-25s.
- 29Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J. Endoscopic total parathyroidectomy by the anterior chest approach for renal hyperparathyroidism. Surg Endosc. 2002; 16(2): 320-322.
- 30Kang J, Fan Y, Guo B, Wu B, Zheng Q. Trans-areola single-site endoscopic parathyroidectomy: report of one case. Surg Innov. 2013; 20: NP16-NP20.
- 31Zhao Q, Wang W, Yu X, Wang Y. Application of transoral endoscopic parathyroidectomy via vestibular approach, endoscopic parathyroidectomy via areola approach for parathyroid adenoma. Eur Arch Otorhinolaryngol. 2020; 278(5): 1559-1565.
- 32Sun Y, Cai H, Bai J, Zhao H, Miao Y. Endoscopic total parathyroidectomy and partial parathyroid tissue autotransplantation for patients with secondary hyperparathyroidism: a new surgical approach. World J Surg. 2009; 33(8): 1674-1679.
- 33Zhang XW, Liu G, Tang XF, Zhang H, Huang JP, Du L. A novel device in parathyroid autotransplantation for 6 patients with secondary hyperparathyroidism—case series. Ann Med Surg. 2012; 2018(35): 51-54.
- 34Du L, Zhang X, Yan L, et al. A practical self-made device in parathyroid autotransplantation for patients with secondary hyperparathyroidism. J Int Med Res. 2019; 47(1): 59-65.
- 35Al Kadah B, Siemer S, Schick B. First experience in the thyroid and parathyroid surgery using the da Vinci® system. Laryngorhinootologie. 2014; 93(1): 25-29.
- 36Takami H, Sasaki Y, Ikeda Y, Tajima G. Intraoperative quick parathyroid hormone assay in the surgical management of hyperparathyroidism. Biomed Pharmacother. 2002; 56(Suppl 1): 26s-30s.
- 37Karakas E, Steinfeldt T, Gockel A, Sesterhenn A, Bartsch DK. Transoral partial parathyroidectomy. Der Chirurg. 2010; 81(11): 1020-1025.
- 38Karakas E, Steinfeldt T, Gockel A, et al. Transoral thyroid and parathyroid surgery—development of a new transoral technique. Surgery. 2011; 150(1): 108-115.
- 39Dralle H. Transoral parathyroidectomy. Der Chirurg. 2014; 85(11):1012.
- 40Karakas E, Steinfeldt T, Gockel A, Mangalo A, Sesterhenn A, Bartsch DK. Transoral parathyroid surgery—a new alternative or nonsense? Langenbecks Arch Surg. 2014; 399(6): 741-745.
- 41Udelsman R, Anuwong A, Oprea AD, et al. Trans-oral vestibular endocrine surgery: a new technique in the United States. Ann Surg. 2016; 264(6): e13-e16.
- 42Nakajo A, Arima H, Hirata M, et al. Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc. 2013; 27(4): 1105-1110.
- 43Wang C, Zhai H, Liu W, et al. Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery. 2014; 155(1): 33-38.
- 44Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016; 40(3): 491-497.
- 45Bhandarwar A, Gala J, Arora E, et al. Endoscopic parathyroidectomy: a retrospective review of 27 cases. Surg Endosc. 2020; 35: 1288-1295.
- 46Russell JO, Clark J, Noureldine SI, et al. Transoral thyroidectomy and parathyroidectomy—a North American series of robotic and endoscopic transoral approaches to the central neck. Oral Oncol. 2017; 71: 75-80.
- 47Sasanakietkul T, Carling T. Primary hyperparathyroidism treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). Surg Endosc. 2017; 31(11): 4832-4833.
- 48Bhargav PRK, Sabaretnam M, Amar V, Devi NV. Applicability of transoral endoscopic parathyroidectomy through vestibular route for primary sporadic hyperparathyroidism: a South Indian experience. J Min Access Surg. 2018; 15(2): 119-123.
- 49Karakas E, Anuwong A, Ketwong K, Kounnamas A, Schopf S, Klein G. Transoral thyroid and parathyroid surgery: implementation and evaluation of the transoral endoscopic technique via the vestibular approach (TOETVA). Der Chirurg. 2018; 89(7): 537-544.
- 50Sasanakietkul T, Jitpratoom P, Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc. 2017; 31(9): 3755-3763.
- 51Wu YJ, Cheng BC, Chiu CH, et al. Successful modified transoral endoscopic parathyroidectomy vestibular approach for secondary hyperparathyroidism with ectopic mediastinal glands. Surg Laparosc Endosc Percutan Tech. 2019; 29(6): e88-e93.
- 52Russell JO, Sahli ZT, Shaear M, Razavi C, Ali K, Tufano RP. Transoral thyroid and parathyroid surgery via the vestibular approach—a 2020 update. Gland Surg. 2020; 9(2): 409-416.
- 53Alshehri M, Mohamed HE, Moulthrop T, Kandil E. Robotic thyroidectomy and parathyroidectomy: an initial experience with retroauricular approach. Head Neck. 2017; 39(8): 1568-1572.
- 54Lee JM, Byeon HK, Choi EC, Koh YW. Robotic excision of a huge parathyroid adenoma via a retroauricular approach. J Craniofac Surg. 2015; 26(1): e55-e58.
- 55Terris DJ, Singer MC, Seybt MW. Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope. 2011; 121(8): 1636-1641.
- 56He Q, Zhu J, Zhuang D, Fan Z. Robotic total parathyroidectomy by the axillo-bilateral-breast approach for secondary hyperparathyroidism: a feasibility study. J Laparoendosc Adv Surg Tech A. 2015; 25(4): 311-313.
- 57Elzahaby IA, Abouzid A, Saleh S, Shetiwy M. Image-guided endoscopic parathyroidectomy using the Axillo-breast approach in the treatment of primary hyperparathyroidism. Surg Laparosc Endosc Percutan Tech. 2020; 30(5): 480-486.
- 58Lee KE, Kim HY, Park WS, et al. Postauricular and axillary approach endoscopic neck surgery: a new technique. World J Surg. 2009; 33(4): 767-772.
- 59Tolley N, Arora A, Palazzo F, et al. Robotic-assisted parathyroidectomy: a feasibility study. Otolaryngol Head Neck Surg. 2011; 144(6): 859-866.
- 60Tolley N, Garas G, Palazzo F, et al. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016; 38(Suppl 1): E300-E306.
- 61Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013; 98(3): 1122-1129.
- 62Ranganath R, Shaear M, Razavi CR, Pace-Asciak P, Russell JO, Tufano RP. Imaging and choosing the right patients for transoral endoscopic parathyroidectomy vestibular approach. World J Otorhinolaryngol Head Neck Surg. 2020; 6(3): 155-160.
- 63Garas G, Holsinger FC, Grant DG, Athanasiou T, Arora A, Tolley N. Is robotic parathyroidectomy a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism? Int J Surg (London, England). 2015; 15: 55-60.
- 64Grogan RH, Suh I, Chomsky-Higgins K, et al. Patient eligibility for transoral endocrine surgery procedures in the United States. JAMA Netw Open. 2019; 2(5):e194829.
- 65Razavi CR, Tufano RP, Russell JO. Completion thyroidectomy via the transoral endoscopic vestibular approach. Gland Surg. 2018; 7(Suppl 1): S77-S79.
- 66Nakao A, Saito Y, Ikeda Y, et al. Total endoscopic thyroidectomy after open neck biopsy of the follicular lymphoma of the thyroid gland. Asian J Endosc Surg. 2020; 14: 275-278.
- 67Ho K, Saito Y, Ikeda Y, et al. Remote-access hemithyroidectomy in a patient with papillary thyroid cancer after ipsilateral irradiation. Gland Surg. 2022; 11(3): 622-627.
- 68Jacobs D, Torabi SJ, Gibson C, Rahmati R, Mehra S, Judson BL. Assessing national utilization trends and outcomes of robotic and endoscopic thyroidectomy in the United States. Otolaryngol Head Neck Surg. 2020; 163(5): 947-955.
- 69Boccara G, Guenoun T, Aidan P. Anesthetic implications for robot-assisted transaxillary thyroid and parathyroid surgery: a report of twenty cases. J Clin Anesth. 2013; 25(6): 508-512.
- 70Mohsin K, Alzahrani H, Bu Ali D, Kang SW, Kandil E. Robotic transaxillary parathyroidectomy. Gland Surg. 2017; 6(4): 410-411.
- 71Hurtado-López LM, Gutiérrez-Román SH, Basurto-Kuba E, Luna-Ortiz K. Endoscopic transoral parathyroidectomy: initial experience. Head Neck. 2019; 41(9): 3334-3337.
- 72Razavi CR, Shaear M, Ranganath R, Russell JO, Tufano RP. Transoral endoscopic parathyroidectomy: early outcomes from a North American series. J Am Coll Surg. 2019; 229(4): S83.
- 73Tae K, Ji YB, Song CM, Ryu J. Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol. 2019; 12(1): 1-11.
- 74Sung ES, Ji YB, Song CM, Yun BR, Chung WS, Tae K. Robotic thyroidectomy: comparison of a postauricular facelift approach with a gasless unilateral axillary approach. Otolaryngol Head Neck Surg. 2016; 154(6): 997-1004.
Citing Literature
