Robotic Head and Neck Surgery: History, Technical Evolution and the Future.

The first application of robotic technology in surgery was described in 1985 when a robot was used to define the trajectory for a stereotactic brain biopsy. Following its successful application in a variety of surgical operations, the da Vinci® robot, the most widely used surgical robot at present, made its clinical debut in otorhinolaryngology and head and neck surgery in 2005 when the first transoral robotic surgery (TORS) resections of base of tongue neoplasms were reported. Subsequently, the indications for TORS rapidly expanded, and they now include tumours of the oropharynx, hypopharynx, parapharyngeal space, and supraglottic larynx, as well as obstructive sleep apnoea (OSA). The da Vinci® robot has also been successfully used for scarless-in-the-neck thyroidectomy and parathyroidectomy. At present, the main barrier to the wider uptake of robotic surgery is the prohibitive cost of the da Vinci® robotic system. Several novel, flexible surgical robots are currently being developed that are likely to not only enhance patient safety and expand current indications but also drive down costs, thus making this innovation more widely available. Future directions relate to overlay technology through augmented reality/AR that allows real-time image-guidance, miniaturisation (nanorobots), and the development of autonomous robots.

Robotic Parathyroid Surgery: Current Perspectives and Future Considerations.

Robotic parathyroidectomy represents a novel surgical approach in the treatment of primary hyperparathyroidism when the parathyroid adenoma has been pre-operatively localised. It represents the "fourth generation" in the evolution of parathyroid surgery following a process of surgical evolution from cervicotomy and 4-gland exploration to a variety of minimally invasive, open and endoscopic, targeted approaches. The existing evidence (levels 2-3) supports it as a feasible and safe technique with equivalent results to targeted open parathyroidectomy for primary hyperparathyroidism in carefully selected patients. However, it takes longer to perform and is more costly than conventional parathyroidectomy. It offers superior cosmesis by completely avoiding a neck scar making it a valid option for those patients who for biological and/or cultural reasons may wish to avoid a neck scar. Robotic parathyroidectomy is not for every patient, surgeon, or hospital. Its application should be confined to high-volume centres and experienced surgeons. Intensive training and proctorship are required for its safe implementation combined with careful patient selection. This particularly relates to the patient's body habitus (BMI < 30 kg/m2) and concordance among the different imaging modalities used pre-operatively. With robotic market competition driving down costs, its role may change. For now, robotic parathyroidectomy occupies a niche role and can only be justified in a select subset of patients.

Parathyroid surgery: from inception to the modern day.

Parathyroid surgery has undergone great changes since its inception less than a century ago. It is still the only definitive option available to cure primary or tertiary hyperparathyroidism. This review details the development of parathyroid surgery, our understanding of hyperparathyroidism and the treatment options available. It also discusses the technological advances that have enabled parathyroid localization and prediction of surgical success.

The history of the parathyroid surgery.

The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment. RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.

The history of the parathyroid surgery / A história da cirurgia das paratireoides

ABSTRACT The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment.

RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.

Vignette hyperparathyroidism: glimpse into its history.

The parathyroid gland was first described by Sir Richard Owen. Ivor Sandstrom coined the term glandulae parathyroidiae. Vassale and Generali Francesco observed that tetany occurs following parathyroidectomy. Harald Salvesen firmly established the relationship of the parathyroid gland to calcium metabolism. A patient with skeletal disease and a tumor near the parathyroid gland was described by Max Askanazy in 1904. Schlagenhaufer suggested in 1915 that in an attempt to cure bone disease, solitary parathyroid enlargement, if present, should be excised. The term hyperparathyroidism (HPT) was coined by Henry Dixon and colleagues. The parathyroid surgeries on Albert J. and Charles Martell were the first experience with successful parathyroidectomy. From a grossly symptomatic disease of bones, stones, abdominal groans, and psychic moans, HPT has evolved into asymptomatic HPT. Improvements in knowledge about the pathology of parathyroid diseases, including the genetic basis of HPT, and advances in the surgical techniques have brought about changes in the management of HPT over the decades.

European endocrine surgery in the 150-year history of Langenbeck's Archives of Surgery.

INTRODUCTION: Founded in 1861 as a German language scientific forum of exchange for European surgeons, Langenbeck's Archives of Surgery quickly advanced to become the premier journal of thyroid surgery before World War I, serving as a point of crystallization for the emerging discipline of endocrine surgery. During the interwar period and, in particular, in the first decades after World War II, Langenbeck's Archives of Surgery lost its dominant position as an international and European medium of publication of top quality articles in the area of endocrine surgery. Nevertheless, the journal remained the chief publication organ of German language articles in the field of endocrine surgery. After a series of key events, Langenbeck's Archives of Surgery managed to reclaim its former position as the leading European journal of endocrine surgery: (1) the formation of endocrine surgery in the early 1980s as a subdiscipline of general and visceral surgery; (2) the change of the language of publication from German to English in 1998; and (3) the journal's appointment in 2004 as the official organ of publication of the European Society of Endocrine Surgeons. CONCLUSION: All in all, the 150-year publication record of Langenbeck's Archives of Surgery closely reflects the history of European Endocrine Surgery. Following the path of seminal articles from Billroth, Kocher, and many other surgical luminaries published in the journal more than 100 years ago, Langenbeck's Archives of Surgery today stands out as the principal European journal in the field of endocrine surgery.

History of parathyroid gland surgery: an historical case series.

The history of the parathyroid glands is a fascinating one full of famous medical names. The discovery of the glands was followed by laborious research into their anatomy, embryology and pathology and into the physiology of calcium metabolism; this led to the manufacture of hormone substitutes and, finally, to the refinement of surgical techniques. The glands were first identified in 1850 by Sir Richard Owen, conservator of the Hunterian Museum, but it was not until 1880 that the term 'glandulae parathyroideae' was first used. The physiology of parathyroid hormone and calcium metabolism eluded physicians and the forefathers of thyroid surgery alike for several decades more. Patients were treated as curiosities and were documented as untreatable medical patients or as inexplicable thyroid surgery complications. Halsted noticed the 'disastrous results from the loss of the glands' and the resulting tetany, as did Billroth. It is the patients, however, who best illustrate the journey of discovery. In this review, we discuss three cases, highlighting their contributions.

Revisión histórica de la embriología: histología y anatomía de las glándulas paratiroides / Historical review of embryology: histology and anatomy of the parathyroid glands

La primera descripción anatómica de las glándulas paratiroides fue expuesta por Richard Owen en 1850 cuando realiza la disección de un rinoceronte indio, publicando su hallazgo en 1862. Remak, en 1855, evidencia estas estructuras en gatos y las asocia con un posible desarrollo embriológico relacionado con el timo. Virchow en 1863 describe estas glándulas como linfonódulos perdidos entre material conectivo en cara posterior de la tiroides. Sin embargo, el hallazgo e identificación de las paratiroides le es designado al sueco Ivar Sandstrõm en 1880, quien las describe primero en perros, luego en otros mamiferos y en el hombre, y además, es el primero en describirlas histológicamente. Así reciben la nominación de "glandulae parathyroidea". Gley en 1892 redescubre las glandulas y establece su importancia como estructuras endocrinas y su relación fisiopatológica con la tetania y la muerte tras tiroidectomías en perros. Kohn en 1895 establece la anatomía, histología y embriología de las paratiroides totalmente independientes de la tiroides. Erdheim (1903) enfatiza su autonomía histológica y realiza nuevas descripciones histólógicas. McCallum y Voegtlin en 1908 relacionan las paratiroides con el control sanguíneo del calcio. Collip, entre 1922-1923, establece el papel fisiológico de las paratiroides sobre la regulación de la calcemia. La primera paratiroidectomía terapéutica es realizada en 1925 por Felix Mandl sobre "Albert", quien padecia problemas óseos. La segunda paratiroidectomía se registra en el Hospital General de Massachussets sobre el capitán Martell en 1926, y tras múltiples intervenciones se realiza el hallazgo de un adenoma paratiroideo mediastinal.

A historical perspective on surgery of the thyroid and parathyroid glands.

The history of thyroid and parathyroid surgery dates back thousands of years, but the developments leading to the contemporary era began just over a century ago. Pioneers in the field include Billroth, Kocher, Mayo, and Halsted. This article examines the historical progress of operating on the thyroid and parathyroid and the impact of physiology on surgery, surgery on physiology, and recent advances in technologies.

History of parathyroid surgery in Puerto Rico.

Review article that includes the worldwide history, as a reference for the readers, and the local history of hyperparathyroidism in Puerto Rico.

History of parathyroid surgery in Puerto Rico

Review article that includes the worldwide history, as a reference for the readers, and the local history of hyperparathyroidism in Puerto Rico.

First parathyroid surgeon: Sir John Bland-Sutton and the parathyroids.

Felix Mandl from Vienna has long been acclaimed as having carried out the first parathyroidectomy for primary hyperparathyroidism in 1925. He was not, however, the first surgeon to have seen the parathyroid glands, either at surgery or in the pathology laboratory. There is evidence that the first intentional removal of a parathyroid tumour was probably carried out at the Middlesex Hospital, London, UK, by Sir John Bland-Sutton at least a decade earlier. Indeed, Sir John Bland-Sutton appeared to have been very much aware of the parathyroid gland and the pathology associated with it for many years, even before this first parathyroid operation. He described a post-mortem specimen of a parathyroid tumour in 1886; he surgically removed a parathyroid cyst in 1909; and then carried out an intentional parathyroidectomy for a parathyroid tumour some time before 1917.

Historical perspective of parathyroid disease.

This article highlights key historical developments in the understanding of parathyroid function and disease, a story that involves many clinical investigators and classic scientific debate. The current medical community is certainly indebted to the innate curiosity and perseverance of these historical figures.

Historical note: the beginning of parathyroidectomy.

The paper describes briefly the major historical steps towards the development of the surgical treatment of hyperparathyroidism. The first parathyroidectomies were carried out in 1925, in Europe and in the United States, independently from each other. The first surgeon in Vienna, F. Mandle, has received a rightly deserved place in the history of medicine, while in Boston the first patient is reminded mostly.