Minimally invasive thoracoscopic resection of mediastinal ectopic parathyroid adenomas using robotic and video-assisted approaches: a three-case series.

Mediastinal ectopic parathyroid adenomas are an uncommon cause of primary hyperparathyroidism and a frequent source of failed cervical exploration. We report three patients with deeply located mediastinal adenomas treated using minimally invasive thoracoscopic approaches-two robot-assisted (RATS) and one video-assisted (VATS). Preoperative localization was achieved with SPECT/CT and, when required, 18F-fluorocholine PET/CT, enabling accurate identification of lesions in para-aortic and aortopulmonary regions. Complete excision was confirmed in all cases by intraoperative parathyroid hormone monitoring according to the Miami criterion. One patient developed a minor pneumothorax; no major complications occurred. All patients achieved a durable biochemical cure. These cases highlight the role of multimodal imaging and demonstrate that minimally invasive thoracoscopic surgery represents a safe and effective treatment option for complex mediastinal ectopic parathyroid adenomas, with the choice of surgical approach tailored to lesion characteristics and surgical expertise.