Robotic Excision of a Mediastinal Parathyroid Adenoma in a Patient With Previous CABG

This video demonstrates the excision of a parathyroid adenoma that was causing severe hypercalcemia. The hypercalcemia was initially treated conservatively. The patient had previously undergone coronary bypass grafting; the risk of redo sternotomy in the face of patent grafts was felt to be too high, and a lateral approach was initially felt to be safer (1).

The hypercalcemia was becoming untreatable, however, as the patient was being admitted regularly for palmidronate treatment and his calcium level was persistently high. Embolization via the left internal mammary artery (LIMA) was attempted, since a small tributary could be seen on the angiogram, but, unfortunately, this caused a LIMA dissection needing emergency stenting and the parathyroid adenoma was not embolized. Computed tomography-guided ablation was also felt to be too high-risk for this patient's graft. Thus, a plan was made to use a robotic system to get to the adenoma and to employ indocyanine green to image the graft.

Reference

1. Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg. 2017;12(1):85.