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      Outcomes of bilateral axillo-breast approach robotic parathyroidectomy versus open parathyroidectomy for primary hyperparathyroidism: a single-institution retrospective study

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          Abstract

          Purpose

          Bilateral axillo-breast approach robotic parathyroidectomy (BABA-RP) aims to remove overactive or enlarged parathyroid glands with no visible neck collar incision. In this study, we compared the safety and surgical outcomes of BABA-RP vs. those of an open surgery group to ascertain whether BABA-RP is a safe and feasible surgical approach for patients with primary hyperparathyroidism (pHPT).

          Methods

          This single-institution retrospective cohort study included 74 patients with primary HPT who underwent open parathyroidectomy (n = 37) or BABA-RP (n = 37) at our institution between November 2014 and March 2023. Patient demographics, biochemical cure rates, operative time, blood loss rates, and complication rates were examined and compared.

          Results

          The patients in the BABA-RP group were younger and had a longer mean operative time. Regarding complication events, 2 patients in the open surgery group and 1 patient in the BABA-RP group had transient hypoparathyroidism. All 74 patients achieved biochemical cure at <6 months, regardless of the approach used. Two patients in the BABA-RP group and 1 patient in the open surgery group had carcinoma on surgical pathology. All 3 patients with parathyroid carcinoma remained recurrence-free at 1-year follow-up.

          Conclusion

          Compared with the open procedure, BABA-RP is a safe and feasible procedure that provides an excellent biochemical cure rate for patients with pHPT and has superior cosmetic benefits with equivalent surgical outcomes.

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          Most cited references23

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          The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism.

          Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades.
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            Incidence and prevalence of primary hyperparathyroidism in a racially mixed population.

            The epidemiology of primary hyperparathyroidism (PHPT) has generally been studied in Caucasian populations. The aim was to examine the incidence and prevalence of PHPT within a racially mixed population. A descriptive epidemiologic study was performed. The study population included 3.5 million enrollees within Kaiser Permanente Southern California. All patients with at least one elevated serum calcium level (>10.5 mg/dL, 2.6 mmol/L) between 1995 and 2010 were included. Cases of PHPT were identified by electronic query of laboratory values using biochemical criteria, after exclusion of secondary or renal and tertiary hyperparathyroidism cases. The incidence and prevalence rates of PHPT were calculated according to sex, race, age group by decade, and year. Initial case finding identified 15,234 patients with chronic hypercalcemia, 13,327 (87%) of which had PHPT as defined by elevated or inappropriately normal parathyroid hormone levels. The incidence of PHPT fluctuated from 34 to 120 per 100,000 person-years (mean 66) among women, and from 13 to 36 (mean 25) among men. With advancing age, incidence increased and sex differences became pronounced (incidence 12-24 per 100,000 for both sexes younger than 50 y; 80 and 36 per 100,000 for women and men aged 50-59 y, respectively; and 196 and 95 for women and men aged 70-79 y, respectively). The incidence of PHPT was highest among blacks (92 women; 46 men, P < .0001), followed by whites (81 women; 29 men), with rates for Asians (52 women, 28 men), Hispanics (49 women, 17 men), and other races (25 women, 6 men) being lower than that for whites (P < .0001). The prevalence of PHPT tripled during the study period, increasing from 76 to 233 per 100,000 women and from 30 to 85 per 100 000 men. Racial differences in prevalence mirrored those found in incidence. PHPT is the predominant cause of hypercalcemia and is increasingly prevalent. Substantial differences are found in the incidence and prevalence of PHPT between races.
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              American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults.

              Hypoparathyroidism (hypoPT) is the most common complication following bilateral thyroid operations. Thyroid surgeons must employ strategies for minimizing and preventing post-thyroidectomy hypoPT. The objective of this American Thyroid Association Surgical Affairs Committee Statement is to provide an overview of its diagnosis, prevention, and treatment.
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                Author and article information

                Journal
                Ann Surg Treat Res
                Ann Surg Treat Res
                ASTR
                Annals of Surgical Treatment and Research
                The Korean Surgical Society
                2288-6575
                2288-6796
                April 2024
                29 March 2024
                : 106
                : 4
                : 203-210
                Affiliations
                [1 ]Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
                [2 ]Deprtment of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA.
                [3 ]Department of Surgery, Seoul National University Hospital, Seoul, Korea.
                [4 ]Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
                [5 ]Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
                [6 ]Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
                Author notes
                Corresponding Author: June Young Choi. Division of Endocrine Surgery, Department of Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel: +82-31-787-7107, Fax: +82-31-787-4078, juneychoi@ 123456snubh.org
                Author information
                https://orcid.org/0009-0008-5912-8371
                https://orcid.org/0000-0001-8240-0689
                https://orcid.org/0009-0006-1159-7895
                https://orcid.org/0000-0001-5820-3001
                https://orcid.org/0000-0003-0615-0563
                https://orcid.org/0000-0001-7338-5157
                https://orcid.org/0000-0001-5511-3596
                https://orcid.org/0000-0001-8830-3433
                https://orcid.org/0000-0001-9990-607X
                https://orcid.org/0000-0002-2354-3599
                Article
                10.4174/astr.2024.106.4.203
                10995836
                38586553
                7cddc9ed-7fb4-4d47-b320-3306a42aceef
                Copyright © 2024, the Korean Surgical Society

                Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 January 2024
                : 01 February 2024
                : 03 February 2024
                Categories
                Original Article
                Thyroid and Endocrine

                parathyroidectomy,primary hyperparathyroidism,robotic surgical procedures

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