Robot-assisted Thoracoscopic Resection of Ectopic Mediastinal Parathyroid Adenoma

Abstract

Hyperparathyroidism, which is primarily caused by excessive parathyroid hormone secretion, can result in hypercalcemia, urinary tract stones, and osteoporosis. Although most cases involve parathyroid adenomas in the cervical region, ectopic adenomas of the mediastinum are rare. This study reports a 78-year-old woman with hypercalcemia and an ectopic mediastinal parathyroid adenoma diagnosed via chest computed tomography and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy. Robot-assisted resection was performed using the da Vinci Xi system. Methylene blue facilitated tumor identification during surgery, and the adenoma was successfully excised without complications. Postoperatively, the calcium and parathyroid hormone levels normalized, and the patient recovered without recurrence.

Ectopic parathyroid adenomas, arising from developmental anomalies, can be challenging to localize and identify; however, imaging techniques such as MIBI and intraoperative methylene blue staining aid in detection. Robot-assisted surgery offers superior visualization and maneuverability compared to traditional methods, especially in confined spaces. It minimizes invasiveness, improves cosmetic outcomes, and reduces recovery time. This case underscores the utility of robotic surgery for the safe and precise removal of ectopic parathyroid adenomas, highlighting its advantages in managing complex mediastinal cases.