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Abstract
Recent technologic advances have engendered alternative and innovative approaches to thyroid surgery aimed at reducing cosmetic sequelae. Minimally invasive techniques via small anterior cervical incisions hidden in natural skin creases and remote access approaches that eliminate anterior neck incisions entirely have emerged as viable options for patients who regard cosmesis as a priority. The safe application of these techniques to both benign and malignant thyroid disease has been evaluated.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - Katrina Chaung
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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102
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Kandil E, Saeed A, Mohamed SE, Alsaleh N, Aslam R, Moulthrop T. Modified robotic-assisted thyroidectomy: an initial experience with the retroauricular approach. Laryngoscope 2014; 125:767-71. [PMID: 24932761 DOI: 10.1002/lary.24786] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/15/2014] [Accepted: 05/06/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS New approaches for robotic-assisted thyroidectomy, including the retroauricular approach, were recently described. We have modified the established surgical approach for retroauricular robotic thyroidectomy. Herein, we report our initial experience to identify challenges and limitations of this new surgical approach. STUDY DESIGN Prospective case series. METHODS This study was performed under institutional review board approval for patients who underwent retroauricular robotic hemithyroidectomy at an academic North American institution. The retroauricular approach was modified by using the space between the two heads of the sternocleidomastoid muscle as our working space. Additionally, selected patients underwent concomitant neck lift surgery with robotic thyroid surgery. Clinical characteristics, total operative time, blood loss, surgical outcomes, and length of hospital stay were evaluated. RESULTS Twelve female patients were included in this study. Mean age was 45 ± 4.43 years, and mean body mass index was 28.6 ± 2.15. Mean thyroid nodule size was 1.15 ± 0.26 cm(3). All cases were completed successfully via single retroauricular incision. There was no conversion to an open approach. Four out of 12 patients (33%) underwent additional concomitant neck lift surgery, with a mean total operative time of 156 ± 15.88 minutes. The mean operative time for the remaining eight patients who underwent the robotic approach without additional neck lift surgery was 145.4 ± 10.08 minutes. There were no cases of permanent vocal cord paralysis or permanent hypoparathyroidism. Mean blood loss was 22.4 ± 4.32 mL. Four patients (33%) were discharged home on the same day of surgery, and the remaining eight patients were discharged after an overnight stay. CONCLUSIONS Single-incision retroauricular robotic hemithyroidectomy can be a safe and feasible alternative to other remote access techniques. Neck lift surgery can be performed safely in a select group of patients. However, future studies are warranted to further evaluate the benefits and limitations of this novel approach.
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Affiliation(s)
- Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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103
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Abstract
Advances in surgical technology and patient-driven demands have fueled exploration into methods to improve cosmetic outcomes in thyroid surgery. This exploration has produced 2 fundamentally different pathways for reducing the visible thyroidectomy scar. Minimally invasive anterior cervical approaches use small incisions hidden in natural skin creases and reduce the overall extent of dissection required to remove the thyroid. Remote access approaches remove the incision from the anterior neck completely but require more extensive dissection to access the thyroid compartment.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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105
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Shin YS, Choi EC, Kim CH, Koh YW. Robot-assisted selective neck dissection combined with facelift parotidectomy in parotid cancer. Head Neck 2014; 36:592-5. [DOI: 10.1002/hed.23441] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yoo Seob Shin
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology; Ajou University School of Medicine; Suwon Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
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106
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107
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108
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Tae K, Ji YB, Song CM, Jeong JH, Cho SH, Lee SH. Robotic Selective Neck Dissection by a Postauricular Facelift Approach. Otolaryngol Head Neck Surg 2013; 150:394-400. [DOI: 10.1177/0194599813515431] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The aim of this study was to investigate the feasibility and efficacy of robot-assisted neck dissection by a postauricular facelift approach in head and neck squamous cell carcinoma (HNSCC), compared with conventional neck dissection. Study Design Case series with chart review. Setting University tertiary care hospital. Subjects and Methods Thirty HNSCC patients with clinically node negative necks (cN0) who underwent robot-assisted selective neck dissection (SND) by a postauricular facelift approach (11 patients, 12 necks) or conventional neck dissection (19 patients, 21 necks). Results The mean age was lower in the robotic group ( P = .030). However, the distributions of gender and TNM stage did not differ between the two groups. The robotic SND was completed successfully in all patients. The mean operative time was longer in the robotic group (215 ± 56 min) than the conventional group (144 ± 43 min) ( P < .001). The mean numbers of lymph nodes removed were 25.0 ± 7.4 and 28.9 ± 8.2 in the robotic and conventional group, respectively ( P = .192), and the number of lymph nodes removed at each level also did not differ between the 2 groups. In addition, there was no significant difference in postoperative complications between the 2 groups, but cosmetic satisfaction was higher in the robot group ( P = .002). Conclusions Robot-assisted SND by a postauricular facelift approach is comparable to conventional neck dissection in selected patients with cN0 HNSCC and results in excellent postoperative cosmesis.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seok Hyun Cho
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hwan Lee
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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109
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Singer MC, Heffernan A, Terris DJ. Defining Anatomical Landmarks for Robotic Facelift Thyroidectomy. World J Surg 2013; 38:92-5. [DOI: 10.1007/s00268-013-2246-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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110
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Robotic Surgery in Otolaryngology: Endocrine. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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111
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Abstract
As minimally invasive surgery has become common in head and neck surgery, the role of robotic surgery has expanded from thyroid surgery and transoral robotic surgery (TORS) of the oropharynx and supraglottic to other areas. Surgeons have advanced the limits of TORS, adapting lasers to the Da Vinci robot for glottic cancer, and combining existing techniques for transoral supraglottic laryngectomy and hypopharyngectomy to perform transoral total laryngectomy. Skull base approaches have been reported with some success in case reports and cadaver models, but the current instrument size and configuration limit the applicability of the current robotic system. Surgeons have reported reconstruction of the head and neck via local and free flaps. Using the previously reported approaches for thyroidectomy via modified facelift incision, neck dissection has also been reported. Future applications of robotic surgery in otolaryngology may be additionally expanded, as several new robotic technologies are under development for endolaryngeal work and neurotology.
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112
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Park YM, Byeon HK, Chung HP, Rho KJ, Kim SH. Robotic Resection of Benign Neck Masses via a Retroauricular Approach. J Laparoendosc Adv Surg Tech A 2013; 23:578-83. [DOI: 10.1089/lap.2012.0468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Pil Chung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Jin Rho
- National Health Insurance Corporation, Ilsan Hospital, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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113
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Tae K, Ji YB, Song CM, Min HJ, Kim KR, Park CW. Robotic Selective Neck Dissection Using a Gasless Postauricular Facelift Approach for Early Head and Neck Cancer: Technical Feasibility and Safety. J Laparoendosc Adv Surg Tech A 2013; 23:240-5. [DOI: 10.1089/lap.2012.0277] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Jung Min
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Rae Kim
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chul Won Park
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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114
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Wharry LI, Stang MT. Robotic Thyroid Surgery. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-012-0007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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115
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Lee HS, Lee D, Koo YC, Shin HA, Koh YW, Choi EC. Endoscopic Resection of Upper Neck Masses via Retroauricular Approach Is Feasible With Excellent Cosmetic Outcomes. J Oral Maxillofac Surg 2013; 71:520-7. [DOI: 10.1016/j.joms.2012.06.170] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/04/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
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116
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Lee S, Park S, Lee CR, Son H, Kim J, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 2013; 27:2407-14. [DOI: 10.1007/s00464-012-2747-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
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117
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Park YM, Lee WJ, Yun IS, Lee DW, Lew DH, Lee JM, Ha JG, Kim WS, Koh YW, Choi EC. Free Flap Reconstruction After Robot-Assisted Neck Dissection Via a Modified Face-Lift or Retroauricular Approach. Ann Surg Oncol 2012; 20:891-8. [DOI: 10.1245/s10434-012-2731-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Indexed: 11/18/2022]
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118
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Robotic surgery in oral and maxillofacial, craniofacial and head and neck surgery: A systematic review of the literature. Int J Oral Maxillofac Surg 2012; 41:1311-24. [DOI: 10.1016/j.ijom.2012.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/05/2012] [Accepted: 05/24/2012] [Indexed: 02/07/2023]
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119
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Lin HS, Folbe AJ, Carron MA, Zuliani GF, Chen W, Yoo GH, Mathog RH. Single-incision transaxillary robotic thyroidectomy: challenges and limitations in a North American population. Otolaryngol Head Neck Surg 2012; 147:1041-6. [PMID: 23008331 DOI: 10.1177/0194599812461610] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population. STUDY DESIGN Case series. SETTING Academic institution. SUBJECTS/METHODS Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter. RESULTS Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days). CONCLUSION Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ho-Sheng Lin
- Department of Otolaryngology-Head & Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, MI 48201, USA.
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120
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Terris DJ, Singer MC. Qualitative and quantitative differences between 2 robotic thyroidectomy techniques. Otolaryngol Head Neck Surg 2012; 147:20-5. [PMID: 22371342 DOI: 10.1177/0194599812439283] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Two distinct remote access robotic thyroidectomy techniques were implemented in a high-volume endocrine surgery practice. Important technical and clinical differences were observed and are described. STUDY DESIGN Cross-sectional study with planned data collection. SETTING Thyroid center. SUBJECTS AND METHODS A panel of demographic and clinical parameters was captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Particular attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay. RESULTS Fifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for RAT averaged 196 ± 38.1 minutes, with no clear downward trend observed. The mean time of surgery for RFT was 156.9 ± 16.3 minutes, with a steady trend toward shorter surgical times. All 5 RAT patients were managed with drains and as inpatients (length of stay = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis (the first patient had a drain and was observed for 1 night in the hospital; P < .001). Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT. CONCLUSIONS In an early experience of a small series of patients, a more rapid learning curve reflected by shorter operative times was observed with robotic facelift thyroidectomy compared with robotic axillary thyroidectomy. Furthermore, the vast majority of patients could be managed as outpatients, which represents one of several apparent advantages.
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Affiliation(s)
- David J Terris
- Department of Otolaryngology-Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia 30912-4060, USA.
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121
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Terris DJ, Singer MC. Robotic facelift thyroidectomy: Facilitating remote access surgery. Head Neck 2012; 34:746-7. [DOI: 10.1002/hed.22978] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/08/2022] Open
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122
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Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 2011; 26:1871-7. [PMID: 22205465 DOI: 10.1007/s00464-011-2116-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy. METHODS The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively. RESULTS Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups. CONCLUSION Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.
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123
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Janus JR, Moore EJ, Price DL, Kasperbauer J. Robotic thyroid surgery: Clinical and anatomic considerations. Clin Anat 2011; 25:40-53. [DOI: 10.1002/ca.22016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/13/2011] [Indexed: 11/05/2022]
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124
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Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions. Eur Arch Otorhinolaryngol 2011; 268:1249-57. [PMID: 21562814 DOI: 10.1007/s00405-011-1620-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 01/25/2023]
Abstract
The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.
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