Jeremy Cox

Robotic-Assisted Parathyroidectomy: A Feasibility Study

Objective. Targeted parathyroidectomy is the gold standard for localized parathyroid disease. A robotic-assisted approach has not been investigated. The aim was to assess the feasibility of a robotic technique that avoids a neck scar. Study Design. Feasibility study. Setting. Tertiary referral center. Subjects and Methods. Eleven patients with primary hyperparathyroidism were prospectively evaluated. Triple modality concordant localization was a prerequisite. All patients underwent robotic-assisted parathyroidectomy (RAP). Outcome variables assessed were operative time, voice change, biochemical cure, and histopathological confirmation. Patient-reported outcome measures (PROMs) included subjective assessment of pain and scar cosmesis, Voice Handicap Index 2, and EQ-5D quality-of-life assessment. Mean follow-up was 6 months (range, 3-12 months). Results. The parathyroid adenoma was successfully excised in all cases with negligible blood loss (<5 mL). There was 1 conversion. There was no voice change in any case. Robot docking time plateaued to 10 minutes after 8 cases. Mean exposure and console times (31 and 51 minutes, respectively) were affected by body habitus. The mean visual analog scale for scar cosmesis was 75% on the first postoperative day, improving to 92% at 6 months and 95% at 1 year. Pain scores decreased to 8% at 2 weeks. All 5 EQ-5D quality-of-life parameters significantly improved following surgery. Conclusion. The robotic approach is feasible for performing targeted parathyroidectomy that avoids a neck scar. The clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted parathyroidectomy warrant further evaluation to establish if this represents a viable alternative to the existing targeted techniques.

Long‐term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism

Targeted parathyroidectomy is a popular technique for localized pathology. No single technique is established as superior. The purpose of this study was to compare robotic‐assisted parathyroidectomy (RAP) with the most common approach.

Clinical outcomes in patients with nonfunctioning pituitary adenomas managed conservatively

The natural history and the optimum management of patients with nonfunctioning pituitary adenomas (NFPAs) are unclear.

Weight loss in a man from West Africa. S. stercoralis hyperinfection.

A 71-year-old man was investigated for recent unintentional weight loss of approximately 15 kg (>20% total body mass) within the past 3 months. His past medical history included type 2 diabetes mellitus and hypertension, and he was an ex-smoker with a 40 pack-year history. Resident in the UK for 50 years, he was originally from Sierra Leone with no recent travel history. Examination revealed cachexia and lymphadenopathy. Admission blood tests demonstrated a white cell count of 12.1×109/L (with eosinophil level raised at 1.0×109/L), microcytic anaemia (haemoglobin of 109 g/L with mean cell volume (MCV) of 68 fl), hypoalbuminaemia (albumin of 20 g/L) and raised inflammatory markers (C reactive protein of 62 mg/L). Tissue transglutaminase IgA levels were within normal limits, with no evidence of IgA deficiency. An abdominal CT with contrast was …

Weight loss in a man from West Africa

A 71-year-old man was investigated for recent unintentional weight loss of approximately 15 kg (>20% total body mass) within the past 3 months. His past medical history included type 2 diabetes mellitus and hypertension, and he was an ex-smoker with a 40 pack-year history. Resident in the UK for 50 years, he was originally from Sierra Leone with no recent travel history. Examination revealed cachexia and lymphadenopathy. Admission blood tests demonstrated a white cell count of 12.1×109/L (with eosinophil level raised at 1.0×109/L), microcytic anaemia (haemoglobin of 109 g/L with mean cell volume (MCV) of 68 fl), hypoalbuminaemia (albumin of 20 g/L) and raised inflammatory markers (C reactive protein of 62 mg/L). Tissue transglutaminase IgA levels were within normal limits, with no evidence of IgA deficiency. An abdominal CT with contrast was …

Editor's quiz: GI snapshot. Weight loss in a man from West Africa

A 71-year-old man was investigated for recent unintentional weight loss of approximately 15 kg (>20% total body mass) within the past 3 months. His past medical history included type 2 diabetes mellitus and hypertension, and he was an ex-smoker with a 40 pack-year history. Resident in the UK for 50 years, he was originally from Sierra Leone with no recent travel history. Examination revealed cachexia and lymphadenopathy. Admission blood tests demonstrated a white cell count of 12.1×109/L (with eosinophil level raised at 1.0×109/L), microcytic anaemia (haemoglobin of 109 g/L with mean cell volume (MCV) of 68 fl), hypoalbuminaemia (albumin of 20 g/L) and raised inflammatory markers (C reactive protein of 62 mg/L). Tissue transglutaminase IgA levels were within normal limits, with no evidence of IgA deficiency. An abdominal CT with contrast was …

Robotic Parathyroidectomy: A Prospective Case Control Study

Objective: 1) To assess the clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted minimally invasive parathyroidectomy. 2) To evaluate whether the absence of a neck scar associated with the robotic approach offers any advantage(s) over conventional targeted minimally invasive parathyroidectomy. 3) To compare patient satisfaction between the 2 techniques. Method: Prospective case control study of 30 patients that underwent targeted parathyroidectomy over 4 years (May 2009-February 2012) in a tertiary referral endocrine center. Fifteen patients had a robotic and 15 an endoscopic approach. Outcomes assessed included operative time, blood loss, biochemistry, pain, scar cosmesis, voice, quality of life, and complications. Results: In all cases the parathyroid adenoma was successfully removed. There was 1 robotic conversion. Mean robotic operative time was approximately double that of the conventional approach. There were no significant differences in mean blood loss. Initial normalization of PTH and adjusted serum calcium levels occurred in 29 cases. The mean visual analogue score (VAS) for scar cosmesis was superior in the robotic cohort from 2 weeks (84% vs 65%, P < .01) to 1 year (94% vs 62%, P < .01). Postoperative VAS pain scores were similar in both groups (P < .05). All EQ5 HD quality of life parameters significantly improved in both cohorts (P < .05). Conclusion: The robotic approach is a feasible “scar-less in the neck” alternative to conventional targeted minimally invasive parathyroidectomy with a superior cosmetic outcome. However, this novel approach is not suitable for all patients and appropriate patient selection is vital. Finally, the high cost of robotic parathyroidectomy currently hinders its more widespread use.

Robotic-Assisted Parathyroidectomy

Objective. Targeted parathyroidectomy is the gold standard for localized parathyroid disease. A robotic-assisted approach has not been investigated. The aim was to assess the feasibility of a robotic technique that avoids a neck scar.Study Design. Feasibility study.Setting. Tertiary referral center.Subjects and Methods. Eleven patients with primary hyperparathyroidism were prospectively evaluated. Triple modality concordant localization was a prerequisite. All patients underwent robotic-assisted parathyroidectomy (RAP). Outcome variables assessed were operative time, voice change, biochemical cure, and histopathological confirmation. Patient-reported outcome measures (PROMs) included subjective assessment of pain and scar cosmesis, Voice Handicap Index 2, and EQ-5D quality-of-life assessment. Mean follow-up was 6 months (range, 3-12 months).Results. The parathyroid adenoma was successfully excised in all cases with negligible blood loss (<5 mL). There was 1 conversion. There was no voice change in any cas...