Robotic-assisted neck surgery spares incision, scar

Surgeons at the University of Illinois Medical Centre at Chicago have performed an innovative robotic-assisted procedure to remove parathyroid glands without an incision or scar on the patient's neck.

Bilal Akbar, 53, suffered from hyperparathyroidism caused by chronic kidney failure. His overactive parathyroid glands produced too much parathyroid hormone (PTH), which caused dangerously high calcium levels in the blood. This can lead to bone, blood vessel and heart damage.

'I'm so glad they didn't have to cut my neck,' said Akbar, who is the first person in the United States or Europe to undergo a robotic parathyroidectomy. He was released from the hospital one day after surgery.

Most people have four tiny parathyroid glands behind or near the thyroid gland. Traditional surgery to remove the parathyroid glands, or the larger thyroid gland, involves making a 4-inch incision in the lower neck, leaving a noticeable scar after surgery.

A surgical team led by Dr Pier Cristoforo Giulianotti, chief of minimally invasive, general and robotic surgery at the medical centre, used the robotic-assisted da Vinci Surgical System to delicately remove two of Akbar's four parathyroid glands.

One small incision was made under the patient's right arm and another tiny incision was made in the chest to accommodate the robotic arms and endoscopic camera.

The parathyroid glands are often difficult to locate, according to Giulianotti, but the da Vinci system provides 3-dimensional visualisation, enhanced magnification and a greater range of motion to locate and remove the glands in the delicate and narrow space of the neck.

During surgery, doctors monitored the patient's parathyroid hormone concentration in the blood. After removing two enlarged non-cancerous tumours of the parathyroid glands, the patient's hormone levels dropped by more than 50 percent, signifying that the glands removed were over-producing the hormone.

'The cosmetic and psychological benefits of the surgery are evident immediately,' said Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. He anticipates that many patients who need parathyroid and thyroid surgery but who are hesitant to have an incision in the neck will be excellent candidates for the robotic-assisted surgery.

In the United States, about 100,000 people develop hyperparathyroidism each year, according to the National Institutes of Health. Women outnumber men two to one, and risk increases with age.

'Robotic parathyroidectomy and thyroidectomy without neck incision can currently be safely performed at the University of Illinois at Chicago,' said Dr Enrico Benedetti, the Warren H. Cole Chair in Surgery and professor and head of surgery at UIC. 'Considering that the vast majority of patients requiring thyroid surgery are women with benign thyroid disease, the avoidance of a neck incision will be extremely important from a cosmetic standpoint in this patient population.'

A small percent of patients who have traditional parathyroid or thyroid surgery may experience temporary or permanent paralysis of the vocal chords.

The risk of injuring the larynx or vocal cords during robotic-assisted surgery is very low, said Giulianotti, an international pioneer in robotic general surgery and past-president of the Minimally Invasive and Robotic Association (MIRA).