At MIOT International, complex cases demand not only advanced technology but also exceptional clinical judgement and multidisciplinary expertise. This case exemplifies how robotic-assisted thoracic surgery enabled the safe and complete removal of a rare parathyroid tumour located dangerously close to vital organs.
A 42-year-old woman presented with a long-standing history of recurrent kidney stones, for which she had already undergone multiple procedures elsewhere. Despite repeated interventions, the underlying cause remained undiagnosed, and the patient continued to experience recurrent symptoms.

A detailed metabolic evaluation at MIOT revealed markedly elevated serum calcium and parathormone (PTH) levels, indicating primary hyperparathyroidism a condition often caused by a parathyroid adenoma.

Diagnostic Challenge

Further evaluation using a Parathyroid MIBI scan identified an unusually large 5.5 cm parathyroid tumour, not in its typical neck location, but deep within the chest (ectopic mediastinal location).

The tumour was found to be:

  • Lying over the protective covering of the heart and lungs
  • Extremely close to major blood vessels supplying the heart
  • Near the main entry point of the right lung
  • In close proximity to the phrenic nerve, which controls diaphragm movement and is essential for breathing
This rare and high-risk location made conventional surgical approaches particularly challenging.

Limitations of Conventional Surgery

Traditionally, tumours in such locations are removed through:

  • Thoracotomy (cutting between the ribs), or
  • Sternotomy (splitting the breastbone)

Both approaches are associated with:

  • Significant postoperative pain
  • Higher risk of complications
  • Longer hospital stay
  • Recovery periods of 2–3 weeks or more
Given the patient’s condition and tumour location, a less invasive yet highly precise approach was critical.

Advanced Surgical Approach: Robotic-Assisted Thoracic Surgery (RATS)

MIOT’s surgical team opted for Robotic-Assisted Thoracic Surgery (RATS), leveraging the precision, magnification, and dexterity of robotic technology.

Using tiny 8-mm keyhole ports, the surgical team:

  • Accessed the tumour without breaking ribs or cutting the chest wall bone
  • Achieved enhanced visualisation of critical structures
  • Carefully dissected the tumour from surrounding vital organs
  • Removed the tumour completely in one piece, along with a small portion of the thymus to minimise the risk of recurrence
Importantly, there was no damage to the heart, lungs, major blood vessels, or nerves.

Intraoperative Confirmation of Success

One of the most compelling indicators of surgical success was biochemical confirmation during the operation itself.Within just 10 minutes of tumour removal, the patient’s parathormone levels dropped dramatically, confirming complete excision of the hormone-producing tumour.

Rapid Recovery and Outcome

The patient’s postoperative course was remarkably smooth:

  • Discharged within 2 days
  • Minimal postoperative pain
  • Normal calcium and parathormone levels restored
  • Returned to normal activities and work within the same week

The resolution of hyperparathyroidism eliminated the root cause of her recurrent kidney stones, significantly improving her long-term health outlook.
Clinical Significance

  • The importance of identifying hidden causes of recurrent conditions
  • The role of advanced imaging in detecting ectopic tumours
  • The transformative impact of robotic-assisted surgery in managing complex thoracic cases

Most importantly, it demonstrates MIOT International’s commitment to delivering precision-driven, patient-centred care even in the most challenging clinical scenarios.

By combining clinical expertise with cutting-edge robotic technology, MIOT successfully treated a rare and high-risk parathyroid tumour that would otherwise have required highly invasive surgery. This case stands as a benchmark in minimally invasive thoracic oncology and endocrine surgery.

To know more about MIOT Institute of Robotic Surgery visit: https://www.miotinternational.com/facilities-and-resources/facilities/miot-institute-of-robotic-surgery/

To know more about MIOT Institute of Cancer Cure: https://www.miotinternational.com/centers-of-excellence/miot-institute-of-cancer-cure/surgical-oncology/