New technique for one gland parathyroidectomy by endoscopic and robotic bilateral axillo-breast approach (BABA): A case series study

Hyeong Won Yu, MD4, Jin Wook Yi, MD4, Ra-Yeong Song4, Joon-Hyop Lee3, Seong Ho Yoo, MD1, Su-jin Kim, MD, PhD4, Young Jun Chai, MD2, June Young Choi, MD3, Kyu Eun Lee, MD, PhD4. 4Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Repubic of Korea, 3Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea, 1Biomedical Research Institute and Institute of Forensic Medicine, Seoul National University Hospital & College of Medicine, Seoul, Republic of Korea, 2Department of Surgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea

Introduction: Bilateral axillo-breast approach (BABA) surgery was first introduced in 2004. This surgical technique is useful in the endocrine operation such as sistrunk operation and parathyroidectomy as well as thyroidectomy due to its excellent magnification and symmetrical view. We report the initial experience of endoscopic and robotic BABA parathyroidectomy.                 

Patients: Five patients who was diagnosed with a primary hyperparathyroidism were studied. All patients underwent endoscopic and robotic parathyroidectomy by bilateral axillo-breast approach from July 2012 to January 2015. Data collected included patients' demographics, operative time, complications, and outcome. Three patients were females (60%) and the median age was 44 years.

Results: Three patients underwent endoscopic BABA parathyroidectomy and two patients received a robotic BABA parathyroidecomy. All patients were diagnosed with primary hyperparathyroidism with a single parathyroid lesion. The mean level of preoperative PTH and iCa were 608.9 pg/mL (82.3 ~ 1931.1) and 1.63 mmol/L (1.4 ~ 1.88). The mean level of postoperative PTH and iCa were 23.14 pg/mL (6.9 ~ 39.8) and 1.28 mmol/L (1.13 ~ 1.56). There were no operation-related complications. The mean operation time was 127 minutes. The patient was discharged from the hospital in 3 days after surgery.

Conclusion: Endoscopic and robotic BABA parathyroidectomy for primary hyperparathyoridism can be a technically feasible and safe procedure with cosmetic advantage.

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