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Albazee E, Abdelaziz A, Alabdulhadi R, Alkandari DI, Abduljabbar A, Sulaiman S, Alnifise M, Ameen J, Magzoub H, Alomar K, Maghdi SA, Abu-Zaid A. Bilateral axillo-breast approach robotic thyroidectomy (BABA-RT) versus transoral robotic thyroidectomy (TORT): a systematic review and meta-analysis. Updates Surg 2023:10.1007/s13304-023-01539-y. [PMID: 37193851 DOI: 10.1007/s13304-023-01539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
The aim of this study is to conduct a systematic review and meta-analysis of all comparative studies that evaluated the surgical outcomes between bilateral axillo-breast approach-robotic thyroidectomy (BABA-RT) and transoral robotic thyroidectomy (TORT). The Cochrane Central Register of Controlled Trials, PubMed, Scopus, and Web of Science databases were screened until July 2022. The Risk of Bias in Non-Randomized Studies for Interventions (ROBINS-I) tool was used to evaluate study quality. The data were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a fixed-effects or random-effects model. Five comparative observational studies met the inclusion criteria comprising 923 patients (TORT = 408 and BABA-RT = 515). The study quality varied and included low (n = 4) and moderate (n = 1) risk of bias. There was no significant difference between both groups regarding the mean operative time (MD = 19.98 min, 95% CI [-11.33, 51.28], p = 0.21), mean hospital stay (MD = -0.14 days, 95% CI [-0.66, 0.38], p = 0.60), mean number of retrieved lymph nodes (MD = 0.42, 95% CI [-0.16, 0.99], p = 0.16), and rate of recurrent laryngeal nerve injury (RR = 0.39, 95% CI [0.13, 1.19], p = 0.10). However, the TORT group had significantly reduced mean postoperative pain score (MD = -0.39, 95% CI [-0.51, -0.26], p < 0.001) and lower rate of hypocalcemia (RR = 0.08, 95% CI [0.02, 0.26], p < 0.001) than the BABA-RT group. TORT and BABA-RT have comparable surgical outcomes. Both methods are largely safe and effective when patients are carefully chosen. However, TORT appears to offer better results regarding postoperative pain and hypocalcemia. Further clinical trials with extended follow-up periods are needed to confirm our findings.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | | | - Reham Alabdulhadi
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | | | - Aysha Abduljabbar
- College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain
| | - Sara Sulaiman
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | | | - Jasem Ameen
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Houda Magzoub
- Touro College of Osteopathic Medicine, Harlem, NY, USA
| | - Karim Alomar
- College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shaima Ali Maghdi
- Department of Surgery, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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Park Y, Yu HW, Lee JK, Choi JH, Kim W, Kwak J, Kim SJ, Chai YJ, Suh H, Choi JY, Lee KE. Effect of body habitus on surgical outcomes following bilateral axillo-breast approach robotic thyroidectomy: a retrospective cohort study. Int J Surg 2023; 109:1257-1263. [PMID: 36999794 PMCID: PMC10389347 DOI: 10.1097/js9.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION BMI has been shown to predict perioperative outcomes in patients undergoing surgery. Most studies assessing the role of body habitus in thyroid surgery have focused on open surgery, with few studies assessing patients undergoing robotic surgery. The present study evaluated the effects of BMI on surgical outcomes in patients undergoing bilateral axillo-breast approach (BABA) robotic thyroidectomy. MATERIALS AND METHODS This study included patients who underwent BABA robotic thyroidectomy between January 2013 and September 2021 at Seoul National University Bundang Hospital. Patients were categorized into six groups based on the WHO classification of overweight and obesity. Clinicopathological characteristics, postoperative complications, and surgical outcomes were evaluated. RESULTS A total of 1921 patients were included. Comparisons of the six BMI groups showed no statistically significant differences in postoperative stay, resection margin involvement, postoperative complications, and recurrence. Subgroup analysis showed that hypocalcemia rates differed among BMI groups in patients who underwent lobectomy, with underweight and class II obese patients being at the highest risk ( P =0.006). However, the actual number of complications was relatively small and similar among the groups. In patients who underwent total thyroidectomy and isthmectomy, BMI was not correlated with postoperative complications, including hypocalcemia, recurrent laryngeal nerve palsy, postoperative bleeding, and chyle leakage. CONCLUSION Body habitus was not significantly associated with operative time and postoperative complications in patients undergoing BABA robotic thyroidectomy, indicating that this approach is safe and feasible in obese patients.
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Affiliation(s)
- Yeshong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Su-jin Kim
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Hyunsuk Suh
- Suh Scarless Thyroid Surgery Center, Tampa, Florida, USA
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
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Ouyang H, Xue W, Zhang Z, Cong R, Sun B, Xia F, Li X. Learning curve for robotic thyroidectomy using BABA: CUSUM analysis of a single surgeon's experience. Front Endocrinol (Lausanne) 2022; 13:942973. [PMID: 36120424 PMCID: PMC9470829 DOI: 10.3389/fendo.2022.942973] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study assessed the safety and oncologic outcomes of robotic thyroidectomy via the bilateral axillary breast approach (BABA RT) for conventional open procedures. The learning curves of BABA RT were further evaluated. METHODS An exact 1:1 matching analysis was performed to compare the technical safety and oncologic outcomes between robotic thyroidectomy and conventional open surgery. Learning curves were assessed using cumulative summation analysis. RESULTS There was no significant difference in general characteristics, short time outcomes (including transient hypoparathyroidism, transient postoperative hoarseness, hematoma/seroma, mean postoperative hospital stay, and other complications), the number of retrieved central lymph nodes, and recurrence rates between robotic BABA and conventional groups. The mean number of retrieved lateral LNs in the robotic group was significantly less than those in the conventional group. The learning curve for working space making, robotic lobectomy, and total thyroidectomy are approximately 15, 30, and 20 cases, respectively. No differences except for operation time were found between the learning group and the proficient group. CONCLUSIONS Robotic thyroidectomy and neck dissection via BABA are feasible in terms of surgical completeness, surgical safety, and oncological safety. Our results provide a criterion for judging whether the surgeon has entered the stable stage of robotic thyroidectomy via BABA in terms of the operative time.
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Affiliation(s)
- Hui Ouyang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbo Xue
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiothoracic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zeyu Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Cong
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Botao Sun
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Fada Xia, ; Botao Sun,
| | - Fada Xia
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Fada Xia, ; Botao Sun,
| | - Xinying Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
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You JY, Kim HK, Kim HY, Fu Y, Chai YJ, Dionigi G, Tufano RP. Bilateral axillo-breast approach robotic thyroidectomy: review of a single surgeon's consecutive 317 cases. Gland Surg 2021; 10:1962-1970. [PMID: 34268080 DOI: 10.21037/gs-21-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
Background Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) is one of the most popular remote-access approaches for thyroid surgery. This study aimed to evaluate the surgical outcomes of BABA RT. Methods Medical records of patients who underwent BABA RT between July 2008 and July 2016 were retrospectively reviewed. Surgeries were performed by one surgeon at one institution. Clinicopathological features and postoperative surgical outcomes were evaluated. Results A total of 317 patients were enrolled. The mean age was 40.0±9.7 years, and 287 (90.5%) were female. The mean tumor size was 1.02 cm. Papillary thyroid carcinoma (PTC) was most commonly seen (n=282, 88.8%), followed by benign nodules (n=33, 10.5%) and follicular thyroid carcinoma (n=2, 0.6%). Total thyroidectomy was performed in 202 (63.7%) patients, while unilateral lobectomy was performed in 113 (35.6%). Two patients (0.6%) had transient vocal cord palsy, but none showed permanent vocal cord palsy. Thirty-four (16.8%) patients developed hypoparathyroidism, 33 (16.3%) were transient and 1 (0.5%) was permanent. The mean operation time for total thyroidectomy and lobectomy was 264.9±52.4 and 203.4±47.6 min, respectively. A decrease in operation time in total thyroidectomy was observed in 49-51 cases (P=0.015). Four patients (1.4%) had local recurrence during the median follow-up of 61±23 months. Conclusions BABA RT can be performed safely in selected patients with thyroid nodules. The learning curve duration for BABA RT was 49-51 cases of total thyroidectomy.
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Affiliation(s)
- Ji Young You
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Kyu Kim
- Department of Surgery, Seoul National University Medical Center, Seoul, Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yantao Fu
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimal Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi', University Hospital "G. Martino", University of Messina, Messina, Italy
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MA, USA
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Sun H, Liu Z, Gao H, Kuang J, Chen X, Li Q, Di Z, Qiu W, Yan J. Predictive factors for prolonged operative time of robotic thyroidectomy via bilateral axillo-breast approach: Analysis of 359 cases of differentiated thyroid cancer. Asian J Surg 2021; 45:105-109. [PMID: 33879363 DOI: 10.1016/j.asjsur.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/26/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study assessed the results of robotic thyroidectomy for differentiated thyroid cancer in early stage, to identify the predictive factors of operative time and complication rate. METHODS A patient cohort of 359 cases in total was involved in this retrospective study. The data of clinical characteristics and follow-up results were collected. RESULTS The cohort of patients involved was composed of 285 female patients and 74 male ones. The mean age was 34.91 ± 7.93 years old. The mean Body Mass Index (BMI) was 22.43 ± 3.47. The mean tumor size was 0.75 ± 0.56 cm, and the mean gland size was 4.68 ± 0.83 cm. Among all the specimen, the ratio of tumor invasion of gland capsule was 63/296, and the ratio of chronic thyroiditis was 110/249. 75 patients underwent total thyroidectomy + central compartment node dissection (CCND). 284 patients underwent Lobectomy + CCND. The ratio of central lymph node metastasis was 144/215 (40.1%). The mean number of lymph node dissected was 5.26 ± 4.09. The mean operative time was 96.53 ± 25.69 min. 21(5.8%) patients had hoarseness after operation. 22(29.3%) patients had hypocalcemia after total thyroidectomy. The inadvertent parathyroidectomy was found in 66(18.4%) cases. The surgical extent (unilateral/bilateral resection), BMI and gland size were found to have a significantly correlation with the operative time (p < 0.05) after multivariate analysis. CONCLUSION The surgical extent, BMI and gland size are found to be independent risk factors of prolonged operative time of robotic thyroidectomy. However, these factors are not associated with a higher complication rate.
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Affiliation(s)
- Hanxing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhuoran Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Haoji Gao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Jie Kuang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xi Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Qinyu Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhongmin Di
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China.
| | - Jiqi Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China.
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D'Orazi V, Sacconi A, Trombetta S, Karpathiotakis M, Pichelli D, Di Lorenzo E, Ortensi A, Urciuoli P, Biffoni M, Ortensi A. May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg 2019; 18:116. [PMID: 31074389 PMCID: PMC7402572 DOI: 10.1186/s12893-018-0447-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022] Open
Abstract
Background Although thyroidectomy is one of the most common surgical procedures performed worldwide, some permanent complications, despite the considerably reducing incidence, may affect dramatically the patients quality of life. The purpose of this study is to evaluate whether factors identified preoperatively and expressed in a score could be predictors of major surgical difficulty during total thyroidectomy and influence the incidence of complications. Methods A total of 164 patients who underwent total thyroidectomy were examined. For each patient we calculated a preoperative score, including seven parameters, which we evaluated to be predictors of difficulty in thyroid surgery, that is, sex, body mass index (BMI), neck length, neck extension, thyroid gland volume, thyroiditis, and increased parenchymal vascularization. The overall score was also compared with peri- and post-operative factors describing objectively the difficulty in thyroid surgery. These factors are the duration of the operation, the length of hospitalization, the incidence of complications such as hemorrhage, hypoparathyroidism, and recurrent laryngeal nerve injuries. Results There was no statistically significant association between our score and either the percentage of postoperative complications or the length of hospitalization. The operative time was the only variable remarkably associated with the score value (p < 0.00001). Comparing the duration of the operation with each of the preoperative predictive factors, we found that none of the factors reached the value of statistical significance, but a close association could be noted with the thyroid volume and the BMI. Conclusions In our study, predictors of difficulty in thyroidectomy did not affect morbidity rates, as suggested by previous studies, but only operative times, which were significantly increased in patients with higher score. Although our results have limited statistical significance, they allow us to confirm the fundamental role of a systematic use of optical magnification and microsurgical technique in thyroidectomy. Further studies, with a larger cohort of patients, are needed to validate our results and to formulate a universally accepted predictive score of difficulty in thyroidectomy preoperatively.
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Affiliation(s)
- Valerio D'Orazi
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy. .,Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.
| | - Andrea Sacconi
- Translational Oncogenomics Unit, Molecular Medicine Area, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Silvia Trombetta
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Menelaos Karpathiotakis
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy.,Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Daniele Pichelli
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Enrico Di Lorenzo
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Department of General Microsurgery and Hand, Surgery Section of phoniatrics and speech therapy, "Fabia Mater" Hospital, Rome, Italy
| | - Alice Ortensi
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Department of General Microsurgery and Hand Surgery, Section of physiotherapy, "Fabia Mater" Hospital, Rome, Italy
| | - Paolo Urciuoli
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Ortensi
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Chief of Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
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Chai YJ, Kim HY, Kim HK, Jun SH, Dionigi G, Anuwong A, Richmon JD, Tufano RP. Comparative analysis of 2 robotic thyroidectomy procedures: Transoral versus bilateral axillo-breast approach. Head Neck 2017; 40:886-892. [DOI: 10.1002/hed.25034] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
- Young Jun Chai
- Department of Surgery; Seoul Metropolitan Government - Seoul National University Boramae Medical Center; Seoul Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine Thyroid Center, Korea University Hospital; Korea University College of Medicine; Seoul Korea
| | - Hong Kyu Kim
- Department of Surgery, Korea University College of Medicine Thyroid Center, Korea University Hospital; Korea University College of Medicine; Seoul Korea
| | - Sang Ho Jun
- Division of Oral and Maxillofacial Surgery, Department of Dentistry; Korea University Anam Hospital; Seoul Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”; University of Messina; Italy
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery; Police General Hospital; Bangkok Thailand
| | - Jeremy D. Richmon
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts
| | - Ralph P. Tufano
- Department of Otolaryngology - Head and Neck Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
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Song CM, Jang YI, Ji YB, Park JS, Kim DS, Tae K. Factors affecting operative time in robotic thyroidectomy. Head Neck 2017; 40:893-903. [PMID: 29206321 DOI: 10.1002/hed.25033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/07/2017] [Accepted: 10/25/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate factors related to operative time in robotic thyroidectomy. METHODS We retrospectively analyzed 240 patients who underwent robotic thyroidectomy. The total thyroidectomy cases and lobectomy cases were both categorized into those with long operative times (LOTs; upper 25% of cases) and those with short operative times (SOTs; lower 25%). RESULTS Among the total thyroidectomy cases, body mass index (BMI) ≥23 kg/m2 (hazard ratio [HR] 5.34; P = .008) and bilateral central neck dissection (CND; HR 14.92; P = .028) were more frequent in the LOT group in multivariate analysis. Among the lobectomy cases, BMI ≥23 kg/m2 (HR 12.92; P = .003) and unilateral CND (HR 21.38; P = .017) were the only independent risk factors for prolonged operative time. CONCLUSION Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.
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Affiliation(s)
- Chang Myeon Song
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Il Jang
- 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
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Liu SYW, Kim JS. Bilateral axillo-breast approach robotic thyroidectomy: review of evidences. Gland Surg 2017; 6:250-257. [PMID: 28713696 DOI: 10.21037/gs.2017.04.05] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The bilateral axillo-breast approach (BABA) is one of the most popular contemporary remote-access thyroidectomy techniques. While the initial experiences with BABA endoscopic thyroidectomy (ET) were associated with some technical challenges and safety concerns, many limitations of the technique could now be substantially overcome by BABA robotic thyroidectomy (RT). In this review, the current literature evidences of BABA RT were analyzed. Data regarding the patient selection, the learning curve, and the comparison with open thyroidectomy (OT) and BABA ET were examined. Careful case selection for BABA RT should be undertaken according to factors related to the patient and the thyroid pathology. The learning curve of BABA RT was about 40 cases. Comparing to OT, BABA RT was comparable to OT for the complication profiles and most perioperative outcomes. But it was associated with longer operative time, higher cost and possibly inferior oncological control with lower number of central lymph node (LN) retrieved. When compared to BABA ET, BABA RT was comparable for most perioperative outcomes except longer operative time and higher cost. Yet, BABA RT was superior to BABA ET for better oncological control. BABA RT is a safe and effective procedure for most benign thyroid conditions and low-risk differentiated thyroid cancers (DTC).
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Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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