Objective To evaluate the safety and effectiveness of surgical treatment of the patients with primary hyperparathyroidism using da Vinci Si surgical system. Methods A retrospective analysis was performed on the clinical data of 12 patients with primary hyperparathyroidism in our department who received robotic-assisted parathyroidectomy using da Vinci Si surgical system from November 2014 to December 2017. Preoperative diagnosis with precise localization of parathyroid had been done. Blood parathyroid hormone, calcium and phosphate levels were detected before and after operation. Postoperative complications such as bleeding, hoarseness and cough of drinking water were analyzed and the patients were followed up from 2 to 24 months. Results All twelve cases had successful robotic parathyroidectomy assisted with the da Vinci Si surgical system. There were no severe operative complications and no conversions to open surgery. The operation time was(58± 17.37)(38~89) min and intraoperative blood loss was(25± 4.75)(20~35) mL. Transient hypocalcemia occurred in 7 cases postoperatively and cured with calcium and vitamin D. The postoperative cosmetic result was excellent. The patients had no postoperative recurrence during the period of follow-up except 1 patient with parathyroid hyperplasia. Conclusions It showed that the surgical treatment of primary hyperparathyroidism assisted with da Vinci Si surgical system was safe and effective when the surgical indication was fully established, especially suitable for the patients with cosmetic requirements.
HE Qingqing, ZHOU Peng, ZHUANG Dayong, ZHU Jian, FAN Ziyi, ZHENG Luming, YUE Tao, WANG Meng, WANG Dan, LI Xiaolei
. Surgical treatment of primary hyperparathyroidism using da Vinci Si surgical system[J]. Journal of Surgery Concepts & Practice, 2018
, 23(02)
: 130
-134
.
DOI: 10.16139/j.1007-9610.2018.02.010
[1] Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism[J]. Br J Surg,1996,83(6):875.
[2] He Q, Zhu J, Zhuang D, et al.Robotic total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation using axillo-bilateral-breast approach for secondary hyperparathyroidism[J]. J Laparoendosc Adv Surg Tech A,2015,25(4):311-313.
[3] 中华医学会骨质疏松和骨矿盐疾病分会, 中华医学会内分泌分会代谢性骨病学组. 原发性甲状旁腺功能亢进症诊疗指南[J]. 中华骨质疏松和骨矿盐疾病杂志,2014,7(3):187-198.
[4] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 机器人手术系统辅助甲状腺和甲状旁腺手术专家共识[J]. 中国实用外科杂志,2016,36(11):1165-1170.
[5] 郭伯敏, 樊友本. 甲状旁腺瘤的内镜手术治疗进展[J].外科理论与实践,2009,14(1):111-114.
[6] 贺青卿, 朱见, 范子义, 等. 达芬奇机器人腋乳径路与传统开放手术治疗甲状腺微小癌的对照研究[J]. 中华外科杂志,2016,54(1):51-55.
[7] 王丹, 朱见, 周鹏, 等. 喉肌电活动实时监测在da Vinci机器人甲状腺手术中的应用[J]. 国际外科学杂志,2016,43(2):115-117,封4.
[8] 樊友本, 张频, 黄玉耀, 等. 原发性甲状旁腺功能亢进的诊治[J]. 外科理论与实践,2005,10(6):525-527.
[9] Profanter C, Schmid T, Prommegger R, et al.Robot-assisted mediastinal parathyroidectomy[J]. Surg Endosc,2004,18(5):868-870.
[10] 周鹏, 庄大勇, 贺青卿, 等. 达芬奇机器人甲状旁腺全切加部分腺体自体移植术治疗肾性甲状旁腺功能亢进[J]. 中华普通外科杂志,2018,33(1):46-49.
[11] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识[J]. 中国实用外科杂志,2016,36(5):481-486.
[12] McCoy KL, Ghodadra AG, Hiremath TG, et al. Sestamibi SPECT/CT versus SPECT only for preoperative localization in primary hyperparathyroidism: a single institution 8-year analysis[J]. Surgery,2018,163(3):643-647.
[13] Li W, Zhu Q, Lai X, et al.Value of preoperative ultrasound-guided fine-needle aspiration for localization in Tc-99m MIBI-negative primary hyperparathyroidism patients[J]. Medicine (Baltimore),2017,96(49):e9051.
[14] 张浩, 贺亮. 定性明确而定位不明确的原发性甲状旁腺功能亢进症不应盲目手术[J]. 中华内分泌代谢杂志,2017,33(11):923-924.
[15] 周鹏, 庄大勇, 贺青卿, 等. FNAC联合FNA-Tg测定在分化型甲状腺癌患者术后随访中的临床应用[J]. 国际外科学杂志,2017,44(12):829-832.
[16] 田文, 杨鹤鸣. 原发性甲状旁腺功能亢进术后并发症的预防及处理[J]. 中国实用外科杂志,2008,28(3):180-182.
[17] 陈曦, 蔡伟耀, 杨卫平, 等. 原发性甲状旁腺功能亢进症的诊断和治疗[J]. 中华普通外科杂志,2003,18(4):225-226.
[18] 王培松, 韩祎, 王硕, 等. PTH监测在原发性甲旁亢手术中的应用[J]. 中华内分泌外科杂志,2017,11(1):20-23,44.
[19] 胡亚, 花苏榕, 王梦一, 等. 可避免的原发性甲状旁腺功能亢进症再次手术临床分析[J]. 中华外科杂志,2017,55(8):582-586.
[20] 朱见, 贺青卿, 庄大勇, 等. 双腋窝乳晕径路达芬奇机器人甲状腺癌手术并发症防治[J]. 国际外科学杂志,2017,44(2):129-132,封4.