1
|
Meyer CD, Wu MP, Miller LE, Mokhtari TE, Richmon JD. Robotic Thyroidectomy via Posterior Neck Approach Using the Da Vinci Single Port System. Laryngoscope 2024; 134:2779-2782. [PMID: 37888781 DOI: 10.1002/lary.31115] [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: 08/06/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
We describe a remote access thyroidectomy technique: robotic thyroidectomy via posterior neck approach using the Da Vinci single port (Sp) robotic system. This approach is feasible and safe in the Western population. Laryngoscope, 134:2779-2782, 2024.
Collapse
Affiliation(s)
- Charles D Meyer
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Michael P Wu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tara E Mokhtari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
2
|
Virós Porcuna D, Suen KH, Stein H, Pollán Guisasola C. New Approaches for Robot-Assisted Neck Surgery: Clavicular and Submental Approaches Using the da Vinci SP System. J Craniofac Surg 2024:00001665-990000000-01642. [PMID: 38810240 DOI: 10.1097/scs.0000000000010297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Minimally invasive robot-assisted thyroid surgery or neck dissection can improve cosmetic results and reduce surgical trauma. Several approaches have been described but each has both advantages and limitations. We aimed to determine the feasibility of performing robot-assisted neck surgery using the da Vinci SP system. METHODS The clavicular approach using the da Vinci SP system was done in 1 cadaveric model. Lateral neck dissection was carried out with parapharyngeal space dissection, lateral thyroid gland exposure, and anatomical references. The submental approach was performed in the same cadaveric model. Total thyroidectomy plus lateral neck dissection was performed. RESULTS The required 2.5-cm skin incision, minimal flap development to insert the SP Access Port plus docking was done in 5 minutes for each procedure. The neck dissection by clavicular access took 77 minutes, the parapharyngeal dissection 60 minutes, and hemi-thyroidectomy 30 minutes. The neck dissection by submental access took 60 minutes and the total thyroidectomy took 45 minutes. CONCLUSION We have demonstrated the feasibility of single-incision clavicular and submental approaches in neck surgery using the da Vinci SP system. The amount of skin flap dissection was minimal, the system docking was rapid, and no additional ports or retractors were required. Further studies on patients are warranted.
Collapse
Affiliation(s)
- David Virós Porcuna
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - Carlos Pollán Guisasola
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
3
|
Yulian ED, Panigoro SS, Melati PA. Retroauricular endoscopic thyroidectomy: initial single-institution experiences. Updates Surg 2024:10.1007/s13304-024-01855-x. [PMID: 38761336 DOI: 10.1007/s13304-024-01855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/10/2024] [Indexed: 05/20/2024]
Abstract
Conventional thyroidectomy often results in visible scarring postoperatively. Endoscopic thyroidectomy offers the advantage of scarless surgery, especially beneficial for young adult women. The retroauricular approach uses a facelift incision well-known among surgeons and eliminates the need for gas insufflation due to the large working space. An early retrospective analysis was conducted on thirty-one individuals who underwent gasless retroauricular endoscopic thyroidectomy approach, focusing on isthmolobectomies (n = 26) and lobectomies (n = 5), with one case necessitating conversion to open thyroidectomy, from January 2016 to April 2017. Physical examination, laboratory, and histopathology findings were collected. The scar was evaluated using the Vancouver Scale System, while other surgical and oncological outcomes were documented and assessed. The average operative time was 154.2 ± 21.3 min, with an average bleeding volume of 69.2 ± 52.1 mL. The average length of stay was 4.7 ± 2.2 days. All complications occurred were temporary and all subjects remained in good condition throughout the follow-up period. Most subjects (65.6%) were very satisfied with the scar concealed in the retroauricular area. Retroauricular endoscopic thyroidectomy is a safe and feasible remote access technique with excellent postoperative results.
Collapse
Affiliation(s)
- Erwin Danil Yulian
- Faculty of Medicine Universitas Indonesia, Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro No. 71, Kenari, Central Jakarta, 10430, Indonesia.
| | - Sonar Soni Panigoro
- Faculty of Medicine Universitas Indonesia, Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jalan Pangeran Diponegoro No. 71, Kenari, Central Jakarta, 10430, Indonesia
| | - Putri Arum Melati
- Faculty of Medicine, Universitas Indonesia, Research Assistant in Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| |
Collapse
|
4
|
Woods AL, Campbell MJ, Graves CE. A scoping review of endoscopic and robotic techniques for lateral neck dissection in thyroid cancer. Front Oncol 2024; 14:1297972. [PMID: 38390267 PMCID: PMC10883677 DOI: 10.3389/fonc.2024.1297972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Lateral neck dissection (LND) in thyroid cancer has traditionally been performed by a transcervical technique with a large collar incision. With the rise of endoscopic, video-assisted, and robotic techniques for thyroidectomy, minimally invasive LND is now being performed more frequently, with better cosmetic outcomes. Methods The purpose of this paper is to review the different minimally invasive and remote access techniques for LND in thyroid cancer. A comprehensive literature review was performed using PubMed and Google Scholar search terms "thyroid cancer" and "lateral neck dissection" and "endoscopy OR robot OR endoscopic OR video-assisted". Results There are multiple surgical options now available within each subset of endoscopic, video-assisted, and robotic LND. The approach dictates the extent of the LND but almost all techniques access levels II-IV, with variability on levels I and V. This review provides an overview of the indications, contraindications, surgical and oncologic outcomes for each technique. Discussion Though data remains limited, endoscopic and robotic techniques for LND are safe, with improved cosmetic results and comparable oncologic and surgical outcomes. Similar to patient selection in minimally invasive thyroidectomy, it is important to consider the extent of the LND and select appropriate surgical candidates.
Collapse
Affiliation(s)
- Alexis L Woods
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Michael J Campbell
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Claire E Graves
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| |
Collapse
|
5
|
Cheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg 2023; 109:4221-4237. [PMID: 37988410 PMCID: PMC10720873 DOI: 10.1097/js9.0000000000000944] [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: 08/14/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.
Collapse
Affiliation(s)
- Xi Cheng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqing Jia
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Guo
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuiyu Xu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haosheng Li
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaodong Wang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqi Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
Granell J, Ramirez-Rosa A, Fernandez-Rastrilla I, Granados-Sitges J, Caballero P, Granell L, Sanchez-Camon I, Mendez-Benegassi I, Gutierrez-Fonseca R. Feasibility of the set-up for the different approaches in robotic head and neck surgery with the Versius Surgical System. J Robot Surg 2023; 17:3035-3038. [PMID: 37610537 DOI: 10.1007/s11701-023-01696-7] [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: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
The Versius Surgical System is a next generation soft-tissue robot with instrument and endoscope arms split into individual modules. Despite its similarities with previous systems, the basic changes in the design raise concerns relating to the feasibility of the set-up for the different approaches in robotic head and neck surgery procedures. We used a complete unit with a surgeon's console and four modules on a training mannequin to depict the different configurations in the operating room. We tested transoral robotic surgery and the four basic configurations for the remote access to the neck: transoral/transvestibular, retroauricular, axillary and bilateral axillo-breast approaches. We obtained a high quality simulation for transoral robotic surgery, as well as for the usual remote access approaches, except for the axillary approach. We were able to obtain an optimal distribution of the modules around the surgical table and an adequate configuration of the joints allowing the instruments to reach their targets. The Versius Surgical System might be an alternative device for robotic procedures in head and neck surgery, although this needs to be proved in a clinical setting.
Collapse
Affiliation(s)
- Jose Granell
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain.
- Department of Otolaryngology-Head and Neck Surgery, HLA Moncloa University Hospital, Madrid, Spain.
- Faculty Bio-Medicine and Health Sciences, European University of Madrid, Madrid, Spain.
| | - Alex Ramirez-Rosa
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
| | - Isabel Fernandez-Rastrilla
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
| | - Juan Granados-Sitges
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
| | - Pablo Caballero
- Department of Maxillofacial Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Lucia Granell
- School of Medicine, Autonomous University, Madrid, Spain
| | - Isabel Sanchez-Camon
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
| | - Ivan Mendez-Benegassi
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
- Department of Otolaryngology-Head and Neck Surgery, HLA Moncloa University Hospital, Madrid, Spain
| | - Raimundo Gutierrez-Fonseca
- Department of Otorhinolaryngology, Rey Juan Carlos University Hospital, Gladiolo St., Mostoles, 28933, Madrid, Spain
- Department of Otorhinolaryngology, Ruber International Hospital, Madrid, Spain
- School of Medicine, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
7
|
Materazzi G, Papini P, Fregoli L, Morganti R, De Palma A, Ambrosini CE, Rossi L. The learning curve on robot-assisted transaxillary thyroidectomy performed by a single endocrine surgeon in a third-level institution in Europe: a cumulative sum (CUSUM) analysis. Updates Surg 2023; 75:1653-1660. [PMID: 37531041 PMCID: PMC10435399 DOI: 10.1007/s13304-023-01619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
Robot-assisted transaxillary thyroidectomy is widely performed in Asian countries, although it is still under discussion in the Western World. However, there have been few studies reporting on the learning curve of robot-assisted transaxillary thyroidectomy. We used the cumulative sum (CUSUM) analysis to assess the learning curve of gasless robot-assisted transaxillary thyroidectomy at a third-level institution in Europe. We included all consecutive patients operated by a single surgeon without previous experience of robotic surgery from February 2012 to January 2023. The primary endpoint of the study was the learning curve extracted from the median operative time using the CUSUM method for the quantitative assessment. Overall, 583 patients were enrolled. The median operative time for thyroid lobectomy and total thyroidectomy was 70 and 90 min, respectively. The CUSUM analysis showed that the learning curve for thyroid lobectomy and total thyroidectomy is 66 and 56 cases, respectively. Moreover, the presence of thyroiditis resulted associated with shorter operative time for total thyroidectomy (p = 0.044), whereas no factors resulted associated with surgical complications. The learning curve for performing robotic transaxillary thyroid lobectomy for a surgeon without previous robotic experience is 66 cases. After that, 56 cases must be performed to acquire proficiency in robotic transaxillary total thyroidectomy. Training programs may reduce the slope of the learning curve.
Collapse
Affiliation(s)
- Gabriele Materazzi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Piermarco Papini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Lorenzo Fregoli
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Andrea De Palma
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| |
Collapse
|
8
|
Choi YS, Choi JH, Jeon MS, Yu MJ, Lee HM, Shin AY, Yi JW. First Experience of Single-Port Robotic Areolar Approach Thyroidectomy. Clin Exp Otorhinolaryngol 2023; 16:275-281. [PMID: 37475141 PMCID: PMC10471905 DOI: 10.21053/ceo.2023.00682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Numerous minimally invasive thyroidectomy techniques have been developed and are actively utilized in hospitals around the globe. Herein, we describe a recently developed minimally invasive thyroidectomy technique that employs the da Vinci SP, and we present the preliminary clinical outcomes of single-port robotic areolar thyroidectomy (SPRA). METHODS A 3-cm semi-circular incision on the right areola and a small 8-mm incision on the left areola were created. Using hydro-dissection and an advanced bipolar device, a subcutaneous skin flap was created, extending from the areola to the thyroid cartilage. The da Vinci SP was then inserted through the incision in the right areola. Between December 2022 and March 2023, 21 SPRA procedures were conducted. Patients' medical records and surgical videos were subsequently reviewed. RESULTS Lobectomy was performed in 17 patients, isthmectomy in 2 patients, and total thyroidectomy in 2 patients. The mean flap time was 14.9±4.2 minutes and the console time was 62.4±17.1 minutes. The mean tumor size was 0.89± 0.65 cm and the number of retrieved lymph nodes was 3.94±3.98 (range, 0-12). There were no observed instances of vocal cord palsy or hypoparathyroidism. CONCLUSION We successfully developed and performed the novel SPRA for the first time worldwide. Unlike other robotic surgery. METHODS SPRA is less invasive and leaves no visible scars. This technique employs a sophisticated single-port robotic device. However, to assess the efficacy of this method, we need to analyze more cases and conduct comparative studies in the near future.
Collapse
Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ji Hyun Choi
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Mi Sook Jeon
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Min Jung Yu
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hye Mi Lee
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ae Young Shin
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
9
|
Khan A, Reddy VS, Gangadhara B, Mayur M, Barad A, Munisiddaiah D, Ramakrishnan A, Sadhoo A, Nayak SP. Robotic infraclavicular approach for minimally invasive neck dissection in head-neck cancers. J Minim Access Surg 2023; 19:395-401. [PMID: 36861532 PMCID: PMC10449050 DOI: 10.4103/jmas.jmas_223_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/21/2022] [Indexed: 02/16/2023] Open
Abstract
Background In the recent years, there has been a rapid increase in the use of robot assisted neck dissection (RAND) as an alternative method for conventional neck dissection. Several recent reports have emphasized upon the feasibility and effectiveness of this technique. However, substantial technical and technological innovation is still essential in spite of the availability of multiple approaches for RAND. Materials and Methods The present study describes a novel technique, i.e., Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA MIND) used in head and neck cancers with the help of Intuitive da Vinci Xi Surgical System. Results After RIA MIND procedure, the patient was discharged on the third post operative day. Also, the total wound size was less than 3.5 cm which enhanced the patient recovery time and required minimal post operative care. The patient was further reviewed 10 days after the procedure for the removal of sutures. Conclusion RIA MIND technique was effective and safe for performing neck dissection for oral, head and neck cancers. However, additional detailed studies will be required for establishing this technique.
Collapse
Affiliation(s)
- Ameenuddin Khan
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - V. Sreekanth Reddy
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - M. Mayur
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Arunkumar Barad
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | | | - Athira Ramakrishnan
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Abhilasha Sadhoo
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sandeep P. Nayak
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
10
|
Lechien JR, Fisichella PM, Dapri G, Russell JO, Hans S. Facelift thyroid surgery: a systematic review of indications, surgical and functional outcomes. J Otolaryngol Head Neck Surg 2023; 52:25. [PMID: 37038204 PMCID: PMC10088190 DOI: 10.1186/s40463-023-00624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/06/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE To investigate indications, surgical and functional outcomes of robotic or endoscopic facelift thyroid surgery (FTS) and whether FTS reported comparable outcomes of other surgical approaches. DATA SOURCES PubMed, Cochrane Library, and Scopus. REVIEW METHODS A literature search was conducted about indications, clinical and surgical outcomes of patients who underwent FTS using PICOTS and PRISMA Statements. Outcomes reviewed included age; gender; indications; pathology; functional evaluations; surgical outcomes and complications. RESULTS Fifteen papers met our inclusion criteria, accounting for 394 patients. Endoscopic or robotic FTS was carried out for benign and malignant thyroid lesions, with or without central neck dissection. Nodule size and thyroid lobe volume did not exceed 6, 10 cm, respectively. FTS reported comparable outcome with transaxillary or oral approaches about operative time, complication rates or drainage features. The mean operative time ranged from 88 to 220 min, depending on the type of surgery (endoscopic vs robotic hemi- or total thyroidectomy). Conversion to open surgery was rare, occurring in 0-6.3% of cases. The most common complications were earlobe hypoesthesia, hematoma, seroma, transient hypocalcemia and transient recurrent nerve palsy. There was an important disparity between studies about the inclusion/exclusion criteria, surgical and functional outcomes. CONCLUSION FTS is a safe and effective approach for thyroid benign and malignant lesions. FTS reports similar complications to conventional thyroidectomy and excellent cosmetic satisfaction.
Collapse
Affiliation(s)
- Jérôme R Lechien
- Robotic Surgery Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- Department of Otolaryngology - Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otolaryngology, Elsan Hospital, Paris, France.
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
| | | | - Giovanni Dapri
- Department of Minimally Invasive General and Oncologic Surgery, Humanitas Gavazzeni University Hospital, Bergamo, Italy
- International School Reduced Scar Laparoscopy, Bergamo, Italy
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Stéphane Hans
- Robotic Surgery Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology - Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| |
Collapse
|
11
|
Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
Collapse
Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
12
|
Vanermen M, Vander Poorten V, Meulemans J. Remote-access robotic thyroidectomy: A systematic review. Int J Med Robot 2023:e2511. [PMID: 36799913 DOI: 10.1002/rcs.2511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/29/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Recently, robotic surgery has been introduced as a new surgical approach to the thyroid. OBJECTIVES The primary objective of this systematic review is to critically examine safety and feasibility of the different robotic approaches. METHODS The literature on robotic thyroidectomy was systematically reviewed. Primary endpoints were surgery duration, length of hospital stay, complications, postoperative pain and cosmetic satisfaction. RESULTS Sixty-eight studies with a total of 14433 patients were included. Depending on the robotic approach used, operative duration ranged between 89 and 230 min and hospitalisation stay between 0.1 and 5.6 days. Complication rates varied between 7.3% and 29%. Postoperative pain visual analogue scores (VAS) ranged from 0.6 to 4.71. CONCLUSION Robotic thyroidectomy results in high cosmetic satisfaction and quality of life. No differences in complication rates between robotic and traditional approaches are observed, supporting safety and feasibility of these robotic techniques.
Collapse
Affiliation(s)
- Margaux Vanermen
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Chen ZX, Chen JB, Pang FS, Lin ZH, Zhang XB, Cai BY, Zheng WW, Cao Y, Qin Y. A novel hybrid approach for "Scarless" (at the neck) lateral neck dissection for papillary thyroid carcinoma: A case series and literature review. Front Oncol 2022; 12:985761. [PMID: 36568147 PMCID: PMC9780263 DOI: 10.3389/fonc.2022.985761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Lateral neck dissection (LND) is a necessary treatment for thyroid cancer with lateral lymph node metastasis. However, the defect created during open surgery leaves a visible scar on the neck. With advancements in surgical technology, many robotic and endoscopic surgical techniques have been reported as alternatives to open surgery. In this study, we present a case series demonstrating the successful application of a novel hybrid approach for endoscopic LND and a review of different surgical approaches for "scarless" (at the neck) LND. We performed endoscopic LND via a combined chest and transoral approach in 24 patients between January 2021 and March 2022. The surgery was completed successfully in all patients with an average operation time of 298.1 ± 72.9 min. The numbers of positive/retrieved lymph nodes at levels II, III-IV, and VI were 0.7 ± 0.9/8.4 ± 4.1, 3.6 ± 2.7/19.5 ± 6.8, and 4.9 ± 3.9/10.3 ± 4.5, respectively. Complications included transient hypoparathyroidism in 10 patients, transient recurrent laryngeal nerve injury in 1 patient, internal jugular vein (IJN) injury in 1 patient, IJN sacrifice due to cancer invasion in 1 patient, and chyle leak in 1 patient, and no cases of tumor recurrence were observed during follow-up. The present case series indicates that the combined chest and transoral approach is feasible and effective for performing LND. Our review of different approaches for "scarless" (at the neck) LND identified advantages and disadvantages for all techniques. Our novel approach has unique advantages, and thus, it can provide an ideal surgical procedure for specific papillary thyroid carcinoma patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - You Qin
- *Correspondence: You Qin, ; Zhen-Xin Chen,
| |
Collapse
|
14
|
Abstract
A shortage of inpatient beds and nurses during the coronavirus disease 2019 pandemic has lent priority to safe same-day discharge after surgery. The minimally invasive nature of robotic surgery has allowed an increasing number of procedures to be done on an outpatient basis. Anesthetic management should be designed to complement the technical advantages of robotic surgery in facilitating early discharge.
Collapse
|
15
|
Alkhatib HH, Ali KM, Tufano RP, Russell JO. Postauricular Robotic Facelift Thyroid Lobectomy on a Patient Using a Single-Port Robotic Surgical System. VideoEndocrinology 2022. [DOI: 10.1089/ve.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hosam H. Alkhatib
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalid M. Ali
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Jonathon O. Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
16
|
Robot-Assisted Total Thyroidectomy with or without Robot-Assisted Neck Dissection in Pediatric Patients with Differentiated Thyroid Cancer. J Clin Med 2022; 11:jcm11123320. [PMID: 35743391 PMCID: PMC9224679 DOI: 10.3390/jcm11123320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/04/2022] Open
Abstract
Pediatric thyroid cancer more frequently develops cervical node metastasis than adult thyroid cancer, even in differentiated thyroid carcinoma (DTC). Thus, cervical neck dissection often needs to be performed simultaneously with thyroidectomy in pediatric patients. Herein, we describe our experience with robot-assisted total thyroidectomy with/without robot-assisted neck dissection in pediatric patients compared with the conventional operated group. A total of 30 pediatric patients who underwent thyroidectomy for DTC between July 2011 and December 2019 were retrospectively reviewed. Among them, 22 underwent robot-assisted operation, whereas 8 underwent conventional operation. There was no statistical difference in the mean operation times, blood loss, drainage amounts, and hospital stay length between the robot-assisted and conventional operation groups; however, the operation time was less in the retroauricular approach subgroup (robot-assisted operation group) with better satisfaction on cosmesis. No postoperative complications, such as seromas, hemorrhages, or hematomas were observed. Our experience suggested that robot-assisted thyroidectomy with or without neck dissection through the retroauricular approach is a feasible and safe alternative treatment, producing outstanding esthetic results compared to the conventional approach, especially in pediatric patients with DTC.
Collapse
|
17
|
Saito Y, Ikeda Y, Takami H, Abdelhamid Ahmed AH, Nakao A, Katoh H, Ho K, Tomita M, Sato M, Tolley NS, Randolph GW. A scoping review of approaches used for remote-access parathyroidectomy: A contemporary review of techniques, tools, pros and cons. Head Neck 2022; 44:1976-1990. [PMID: 35467046 DOI: 10.1002/hed.27068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.
Collapse
Affiliation(s)
- Yoshiyuki Saito
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, International Goodwill Hospital, Yokohama, Japan.,Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Ikeda
- Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
| | | | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Atsushi Nakao
- Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hiroshi Katoh
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keiso Ho
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Michio Sato
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | | | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Kasouli A, Spartalis E, Giannakodimos A, Tsourouflis G, Dimitroulis D, Nikiteas NI. Comparison of cosmetic outcomes between remote‐access and conventional thyroidectomy: A review of the current literature. World J Otorhinolaryngol Head Neck Surg 2022; 9:1-8. [PMID: 37006748 PMCID: PMC10050956 DOI: 10.1002/wjo2.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The pursuit of an esthetically pleasing scar following open thyroid surgery has led to the development of endoscopic thyroidectomy through remote incisions placed in several locations outside the neck. The objective of this study is to review the recent literature and compare the incision site appearance and patient satisfaction with the cosmetic outcome after extracervical and conventional thyroidectomy. Methods The English literature published since 2010 was searched through the PubMed/Medline database for studies comparing the cosmetic outcomes between remote-access endoscopic and conventional thyroidectomy using a form of scar assessment scale. Results A total of 9 relevant papers fulfilled the eligibility criteria including 1486 patients. Among them, 595 patients underwent endoscopic thyroidectomy through several remote-access approaches and 891 patients were assigned to the conventional group. Only one randomized-controlled trial was identified, whereas among the rest, four were prospective and four were retrospective nonrandomized cohorts. Regarding the extracervical modifications performed in the endoscopic groups, the axillary approach was performed in three studies and the breast approach in four studies, while the retroauricular facelift technique and the transoral vestibular method were applied in one study, respectively. Conclusions Evaluation of the wound appearance and patient satisfaction with the cosmetic outcome at various time points during the follow-up highlighted the superiority of the extracervical approaches over the conventional cervicotomy. Considering these findings, remote-access techniques could possibly be the ideal surgical method for patients with high esthetic requirements, providing an excellent appearance of the thoroughly exposed neck.
Collapse
Affiliation(s)
- Anna Kasouli
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
- 2nd Department of Propaedeutic Surgery, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Alexios Giannakodimos
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
- 2nd Department of Propaedeutic Surgery, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
- 2nd Department of Propaedeutic Surgery, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
- 2nd Department of Propaedeutic Surgery, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Nikolaos I. Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School Athens National and Kapodistrian University of Athens Athens Greece
- 2nd Department of Propaedeutic Surgery, Medical School National and Kapodistrian University of Athens Athens Greece
| |
Collapse
|
19
|
Transoral robotic thyroidectomy: First case as a new technique in Vietnam. Oral Oncol 2021; 122:105542. [PMID: 34571461 DOI: 10.1016/j.oraloncology.2021.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
|
20
|
Bhoi D, Bhatia R, Mohan VK, Thakar A, Kalagara R, Sikka K. Efficacy of Ultrasound-Guided Intermediate Cervical Plexus Block by Anterior Route for Perioperative Analgesia in Robotic Thyroidectomy by Retroauricular Approach: A Case Series. A A Pract 2021; 15:e01501. [PMID: 34388135 DOI: 10.1213/xaa.0000000000001501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Retroauricular or facelift approach for robotic thyroidectomy involves a long incision with extensive subcutaneous dissection causing severe pain and discomfort. Multimodal analgesic regimen with inclusion of intermediate cervical plexus block by anterior route provided excellent perioperative analgesia without affecting recurrent laryngeal nerve monitoring in 10 cases. All the patients were monitored with bispectral index (maintained 40-60) and extubated on table. Median numeric pain rating scale score in 24 hours postoperatively was 3. None of the cases had any significant complications on follow-up.
Collapse
Affiliation(s)
- Debesh Bhoi
- From the Departments of Anaesthesiology, Pain Medicine and Critical Care
| | - Ridhima Bhatia
- From the Departments of Anaesthesiology, Pain Medicine and Critical Care
| | - Virender K Mohan
- From the Departments of Anaesthesiology, Pain Medicine and Critical Care
| | - Alok Thakar
- Otolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Reshma Kalagara
- From the Departments of Anaesthesiology, Pain Medicine and Critical Care
| | - Kapil Sikka
- Otolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
21
|
Han SH, Chung E. Robotic retroauricular thyroidectomy with additional axillary port: Early personal experiences. Laryngoscope Investig Otolaryngol 2021; 6:885-891. [PMID: 34401517 PMCID: PMC8356877 DOI: 10.1002/lio2.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the usefulness of an additional axillary port in robotic retroauricular thyroidectomy by comparing the perioperative data and postoperative function between the operations with and without an additional axillary port. MATERIALS AND METHODS A retrospective review of the medical records of 11 patients who underwent robotic thyroid operations using a unilateral retroauricular approach with or without an additional axillary port between 2016 and 2021 was conducted. Patient demographics, operation time, drainage amount, hospital stay, complication, postoperative cosmetic satisfaction, and postoperative neck and shoulder pain were analyzed. RESULTS Among the 11 patients who underwent robotic retroauricular thyroidectomy, an additional axillary port was used in 6 patients and not used in 5 patients. The total operation time was significantly shorter in the axillary port group (174.5 ± 23 minutes) compared to the without the axillary port group (207.6 ± 20.1 minutes) (P = .033). The intraoperative estimated blood loss (P = .525), total amount of drainage (P = .172), and postoperative hospital stays (P = .092) were not different between the 2 groups. There was no postoperative recurrent laryngeal nerve palsy, hypoparathyroidism, hematoma, seroma in the two groups. There was no significant difference for either group in the pain score and cosmetic satisfaction at 2 weeks (P = .378, P = .650) and 6 weeks (P = .242, P = .546) postoperatively. CONCLUSION Robotic retroauricular thyroidectomy using an additional axillary port was a novel, safe, and feasible procedure. Dissection was easy due to the availability of the fourth robotic arm to retract the thyroid gland.Level of Evidence: 4.
Collapse
Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
| | - Eun‐Jae Chung
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
| |
Collapse
|
22
|
Park JO. Current concepts in thyroid gland surgery: transoral endoscopic and robotic surgical procedures. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.3.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The increased incidence of thyroid cancer in young females may raise concerns about visible hypertrophic scarring on the center of the neck after thyroid gland surgery. Therefore, endoscopic surgical procedures have attracted significant interest from patients with thyroid cancer, leading to the development of various endoscopic and robotic approaches. Although the cosmetic outcomes of current endoscopic and robotic thyroid surgeries have been excellent, all the procedures still require a large incision and extensive flap elevation. Transoral endoscopic thyroid surgery is a newly developed surgical method performed by inserting an endoscope through a mucosal opening created in the mouth, obviating the need for a skin incision. Additionally, the dissection area is relatively small and no dressings are required. Showering or shaving may resume the day after surgery and the port created within the oral mucous membrane generally heals within one week. Importantly, this approach is markedly less invasive than other endoscopic approaches. Although transoral endoscopic thyroid surgery has not yet been universally accepted, it may emerge as the preferred method for thyroid surgery in the near future.
Collapse
|
23
|
Chen LW, Assadi N, Hefetz-Kirshenbaum L, Hong H, Razavi CR, Grogan RH, Tufano RP, Khafif A, Russell JO. Preferences for thyroidectomy technique: Comparing traditional and transoral approaches. Head Neck 2021; 43:1747-1758. [PMID: 33555089 DOI: 10.1002/hed.26627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We investigated preferences between the transcervical and transoral thyroidectomy approach in the United States and Israel. METHODS An online survey assessing scar attitudes and surgical preferences, in English and Hebrew, was distributed on ThyCa.com and other platforms. RESULTS 928 and 339 responses from the United States and Israel cohorts, respectively, were analyzed. In both countries, individuals without prior thyroidectomy preferred a scarless approach when hypothetical risks equaled those of traditional thyroidectomy (77% United States, 76% Israel, p = 0.61). U.S. respondents without thyroidectomy had greater preference to avoid a scar and would pay more to do so than those with thyroidectomy (both p < 0.001). Many respondents with prior thyroidectomy still expressed interest in scarless alternatives (57% United States). CONCLUSIONS Populations in Israel and the United States prefer scarless thyroidectomy when risks equal the traditional approach. While individuals without prior thyroidectomy are more likely to favor a scarless option, former thyroidectomy patients may have preferred avoiding a scar.
Collapse
Affiliation(s)
- Lena W Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niddal Assadi
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Lior Hefetz-Kirshenbaum
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymon H Grogan
- Endocrine Surgery Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avi Khafif
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
24
|
Lee DW, Bang HS, Jeong JH, Kwak SG, Choi YY, Tae K. Cosmetic outcomes after transoral robotic thyroidectomy: Comparison with transaxillary, postauricular, and conventional approaches. Oral Oncol 2021; 114:105139. [PMID: 33460884 DOI: 10.1016/j.oraloncology.2020.105139] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Transoral thyroidectomy does not involve neck incision, and its postoperative cosmetic outcome is thought to be superior to that of conventional thyroidectomy and other remote-access procedures. This study aimed to compare the cosmetic outcomes between transoral robotic thyroidectomy (TORT) and conventional transcervical thyroidectomy and two common remote-access robotic thyroidectomies via the transaxillary and postauricular approaches. MATERIALS AND METHODS We analyzed 160 patients who underwent TORT, robotic thyroidectomies via the transaxillary or postauricular approach, or conventional transcervical thyroidectomy (40 patients in each group). The postoperative cosmetic outcomes, including cosmetic satisfaction and scar consciousness scores, were evaluated using self-assessment cosmesis questionnaires at 3 months and 1 year postoperatively. The cosmesis index was defined as the sum of the percentage scores for cosmetic satisfaction and scar consciousness. RESULTS Cosmetic satisfaction scores, scar consciousness scores, and cosmesis indexes were significantly higher for the transoral, transaxillary, and postauricular approaches than the conventional approach at 3 months and 1 year postoperatively. There was a trend of better cosmetic outcomes, especially regarding scar consciousness, for the transoral and transaxillary approaches than for the postauricular approach, but the difference was not statistically significant. CONCLUSION Postoperative cosmesis of TORT, as well as the transaxillary and postauricular approaches, is superior to that of conventional thyroidectomy. The cosmetic outcomes of the transoral and transaxillary approaches seem to be better than those of the postauricular approach.
Collapse
Affiliation(s)
- Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea; Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Hyang Sook Bang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Sang Gyu Kwak
- Department of Medical Statistics, School of Medicine, Catholic University of Daegu, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea.
| | - Yun Young Choi
- Department of Nuclear Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| |
Collapse
|
25
|
von Ahnen T, Wirth U, von Ahnen M, Kroenke J, Busch P, Schardey HM, Schopf S. Endoscopic cephalic access thyroid surgery (EndoCATS) using the retroauricular approach - a single centre retrospective data analysis. Surg Endosc 2021; 36:117-125. [PMID: 33427912 DOI: 10.1007/s00464-020-08244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Due to improvements in endoscopic as well as robotic technology, and a request for better cosmetic results, there was a significant increase in thyroid surgery using these methods during the past decade. METHODS The aim of our study is to evaluate the perioperative short- and long-term outcome as well as the learning curve of EndoCATS and the Quality of Life (QoL). RESULTS A total of 150 patients with 152 hemithyroidectomies who underwent endoscopic thyroid surgery by EndoCATS between 2010 and 2016 were enrolled in this study. The mean specimen volume was 15.04 g ± 7.89 g. The mean operation time was 132.79 ± 50.52 min. There is a significant reduction of the operation time after the 53th case. (p < 0.05) There was no acute rebleeding or permanent hypoparathyroidism. Permanent RLN palsy occurred in 3 nerves at risk (NAR) 1.97%. There were no cases of pneumothorax, postoperative infections or skin flap ischemia. 94.11% of the patients describe their state of general health as good as or better than before the surgery. CONCLUSIONS EndoCATS is a safe and effective, but a demanding single port access procedure; therefore, extensive training is required. An advantage is the near ideal visualization of the RLN and the parathyroid glands as well as the ability to recover even large specimens without difficulties.
Collapse
Affiliation(s)
- Thomas von Ahnen
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.
| | - Ulrich Wirth
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin von Ahnen
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Julia Kroenke
- Department of Radiology, Agatharied Hospital, Hausham, Germany
| | - Peter Busch
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Hans-Martin Schardey
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Stefan Schopf
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.,Department of General Surgery, RoMed Klinik Bad, Aibling, Germany
| |
Collapse
|
26
|
Kandil E, Attia AS, Hadedeya D, Shihabi A, Elnahla A. Robotic Thyroidectomy. Otolaryngol Clin North Am 2020; 53:1031-1039. [DOI: 10.1016/j.otc.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
27
|
Kandil E, Akkera M, Shalaby H, Munshi R, Attia A, Elnahla A, Shalaby M, Abdelgawad M, Grace L, Kang SW. A Single Surgeon's 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery. Am Surg 2020; 87:638-644. [PMID: 33142070 DOI: 10.1177/0003134820950300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America. . METHODS This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. RESULTS Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. DISCUSSION Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.
Collapse
Affiliation(s)
- Emad Kandil
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mounika Akkera
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hosam Shalaby
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ruhul Munshi
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdallah Attia
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ahmed Elnahla
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Abdelgawad
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lee Grace
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sang W Kang
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
28
|
The current status of remote access thyroidectomy in the United States. Surgery 2020; 168:845-850. [DOI: 10.1016/j.surg.2020.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022]
|
29
|
Moreno Llorente P, A Gonzales Laguado E, Alberich Prats M, Francos Martínez JM, García Barrasa A. Surgical approaches to thyroid. Cir Esp 2020; 99:267-275. [PMID: 33069356 DOI: 10.1016/j.ciresp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
Collapse
Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - Erick A Gonzales Laguado
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Alberich Prats
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
30
|
Noel JE, Lee MC, Tam K, Lim GC, Holsinger FC, Koh YW. Retroauricular thyroidectomy with a single-arm robotic surgical system: Preclinical cadaveric study. Head Neck 2020; 42:3663-3669. [PMID: 32852084 DOI: 10.1002/hed.26436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/28/2020] [Accepted: 08/03/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In this study, we evaluate a new flexible, single-arm robotic system in performing thyroidectomy via a retroauricular approach. METHODS Four fresh cadavers were used. Technical details of the new system are discussed, and the comprehensive surgical procedures are described step by step. RESULTS This single-port flexible system could be used to successfully perform retroauricular thyroidectomy. The ideal angle to dock the patient-side cart was at a 90° angle to the operating table. When the cannula tip was placed 10 to 15 cm away from the skin incision, positioning and full movement of all four instruments without collisions were possible. Three flexible instruments and an endoscope made the robotic dissection more efficient. CONCLUSIONS We describe the first preclinical evaluation of an innovative, flexible, single-arm robotic surgical system for retroauricular thyroidectomy.
Collapse
Affiliation(s)
- Julia E Noel
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Myung-Chul Lee
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA.,Department of Otorhinolaryngology Head & Neck Surgery, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Kenric Tam
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Gil-Chai Lim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
31
|
Chen LW, Razavi CR, Hong H, Fondong A, Ranganath R, Khatri S, Mydlarz WK, Mathur A, Ishii M, Nellis J, Shaear M, Tufano RP, Russell JO. Cosmetic outcomes following transoral versus transcervical thyroidectomy. Head Neck 2020; 42:3336-3344. [DOI: 10.1002/hed.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lena W. Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Christopher R. Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Akeweh Fondong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Surya Khatri
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech K. Mydlarz
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Aarti Mathur
- Division of Surgical Oncology, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Masaru Ishii
- Division of Rhinology and Sinus, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jason Nellis
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| |
Collapse
|
32
|
|
33
|
Abstract
Various remote access robotic thyroidectomy techniques have been developed using the da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA) to hide or avoid neck scarring and overcome the limitations of endoscopic thyroidectomy. Among those used today are the gasless transaxillary approach, the bilateral axillo-breast approach (BABA), the gasless postauricular facelift approach, and the transoral approach. Especially, the recently introduced transoral approach (including robotic and endoscopic procedures) is prominent and now popular worldwide. The most significant advantages of remote access robotic thyroidectomy are excellent postoperative cosmesis and voice outcomes. The important limitations to the adoption of robotic thyroidectomy are the difficult technique, high complication rate during the learning curve, and high cost. In addition, cultural differences, longer operative times, and medicolegal issues are a barrier to the diffusion of robotic thyroidectomy. However, remote access robotic thyroidectomy is feasible, and the outcomes are comparable to those of conventional transcervical thyroidectomy if performed by experienced surgeons in highly selected patients. This article reviews the evolution and recent advances in robotic thyroid surgery.
Collapse
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| |
Collapse
|
34
|
Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve. Oral Oncol 2020; 110:104871. [PMID: 32619928 DOI: 10.1016/j.oraloncology.2020.104871] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/06/2020] [Accepted: 06/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Since 2018, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a true scarless thyroid surgery. In this study, we explore early outcomes and learning curve of this new approach. METHODS A retrospective cohort including conventional thyroidectomies and TOETVAs performed in a cancer center was designed. Learning curve and early surgical outcomes of TOETVA were assessed and compared to conventional thyroidectomy. RESULTS A total of 56 TOETVAs and 745 conventional thyroid procedures were included. In the TOETVA group, we had a 14.4% total complication rate with no permanent vocal cord paresis or hypocalcemia. The mean surgical time dropped from 167 to 117 min (p = 0.0001) after the 15 first cases. Comparing to conventional procedures, we didn't find any significant difference in complications rate. Operative time was longer in the TOETVA group. CONCLUSIONS In this study, TOETVA was safe and feasible, with a learning curve of 15 cases.
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW To provide an overview of the feasibility and safety of current minimally invasive remote-access approaches for thyroid surgery, in view of the amounting new challenges and paradigm shifts in the management of thyroid pathologies. RECENT FINDINGS Over the past two decades, several remote-access approaches for thyroid surgery have been developed to improve cosmesis; however, none has been widely adopted extensively in the Western world. The recently emerged transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is the only true minimally invasive approach, completely avoiding skin incisions. It has a relatively short learning curve, midline surgical view, accessible surgical equipment, and relatively broad inclusion criteria with promising surgical outcomes as reported to date. TOETVA has proven to be safe and feasible for carefully selected patients. Further experience and long-term follow-up are needed to define the added value of TOETVA except for improved cosmetic outcome.
Collapse
|
36
|
Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach: does size matter anymore? J Endocrinol Invest 2020; 43:615-622. [PMID: 31989449 DOI: 10.1007/s40618-019-01149-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Various approaches for endoscopic and minimally invasive thyroid operations have been reported, with some becoming popular to date. The aim of these procedures is to reduce and prevent visible scars in the neck. This led to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique applicable in small thyroid specimen. To amend TOETVA and to broaden the indication for transoral thyroid surgery, our aim was to combine the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach. METHODS After successful implementation of the TOETVA technique in 2017, we evaluated the transoral technique regarding feasibility and safety in well-selected patients in Germany and Austria. With the combination of TOETVA and EndoCATS, we were able to optimize the extraction process of the specimen by avoiding damage to the thyroid capsule and to broaden the indication of transoral surgery by operating on thyroid glands with higher volume. Patients' characteristics, surgical outcome and complications were determined. RESULTS Seventy-one transoral procedures were performed in 70 patients. The TOETVA procedure was performed in 60 patients, and 10 female patients underwent TOVARA with transoral thyroid lobe mobilization and removal of the specimen via the retroauricular access. Overall, median operation time was 205 min (range 96-370 min) and permanent RLNP rate was 1% accordant to 99 nerves at risk (39 hemithyroidectomies, 29 total thyroidectomies, 2 parathyroid resections, and 1 thyroglossal cyst resection). No conversion to conventional open surgery was necessary. Long-term mental nerve injury occurred in two patients. No infection was identified. CONCLUSIONS Transoral thyroid and parathyroid surgery via the vestibular approach is both feasible and safe in Western Europe. The combination of the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach, called TOVARA, is a promising opportunity to allow for thyroid surgery without a visible scar in specimen with volume of more than 40 ml also.
Collapse
Affiliation(s)
- E Karakas
- Department of General, Abdominal and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, 47805, Krefeld, Germany.
- University of Marburg, Marburg, Germany.
| | - G Klein
- Department of Surgery, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - S Schopf
- Department of General, Abdominal and Vascular Surgery, Hospital Agatharied GmbH, Hausham, Germany
| |
Collapse
|
37
|
Rao V, Subash A, Sinha P, Prasad R, Majumdar K, Puranik P. Modified facelift approach for posterior segmental mandibulectomy: a blend of oncology and cosmesis. Eur Arch Otorhinolaryngol 2020; 277:1205-1210. [DOI: 10.1007/s00405-020-05793-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
|
38
|
Pace-Asciak P, Russell JO, Shaear M, Tufano RP. Novel Approaches for Treating Autonomously Functioning Thyroid Nodules. Front Endocrinol (Lausanne) 2020; 11:565371. [PMID: 33250857 PMCID: PMC7673400 DOI: 10.3389/fendo.2020.565371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.
Collapse
|
39
|
Pérez-Soto RH, Ponce de León-Ballesteros G, Montalvo-Hernández J, Sierra-Salazar M, Pantoja Millán JP, Herrera-Hernández MF, Velázquez-Fernández D. Transoral Endoscopic Thyroidectomy by Vestibular Approach—Initial Experience and Comparative Analysis in the First Reported Mexican Cohort. J Laparoendosc Adv Surg Tech A 2019; 29:1526-1531. [DOI: 10.1089/lap.2019.0537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rafael Humberto Pérez-Soto
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Ponce de León-Ballesteros
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Mauricio Sierra-Salazar
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Juan Pablo Pantoja Millán
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Miguel Francisco Herrera-Hernández
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute for Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
40
|
Lee DW, Ko SH, Song CM, Ji YB, Kim JK, Tae K. Comparison of postoperative cosmesis in transaxillary, postauricular facelift, and conventional transcervical thyroidectomy. Surg Endosc 2019; 34:3388-3397. [PMID: 31515625 DOI: 10.1007/s00464-019-07113-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 08/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The most important advantage of remote-access robotic and endoscopic thyroidectomies is believed to be the excellent postoperative cosmesis. The purpose of this study was to compare directly the postoperative cosmetic outcomes of robotic/endoscopic thyroidectomy via gasless transaxillary and postauricular facelift approaches with those of conventional thyroidectomy. METHODS We prospectively studied 100 patients who underwent robotic/endoscopic thyroidectomy using a gasless unilateral axillary (GUA) approach (50 patients) or a postauricular facelift approach (50 patients), and 50 who underwent conventional transcervical thyroidectomy. Postoperative cosmetic satisfaction scores and scar consciousness scores were evaluated at 3 months and 1 year after surgery using questionnaires developed by us. Vancouver scar scales were evaluated at the same time. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1-5 each. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0-3 each. RESULTS The cosmetic satisfaction and scar consciousness scores were significantly lower (corresponding to greater satisfaction) in the transaxillary and postauricular facelift groups than the conventional group at 3 months and 1 year postoperatively. They did not differ between the transaxillary and postauricular facelift groups. However, the Vancouver scar scale score of the conventional group was significantly lower than those of the transaxillary and postauricular facelift groups (P < 0.001 in both). CONCLUSION Robotic/endoscopic thyroidectomy via transaxillary or postauricular facelift approaches results in better cosmesis than the conventional approach. However, scar healing itself is worse in the transaxillary and facelift approaches than the conventional approach.
Collapse
Affiliation(s)
- Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Seok Hwa Ko
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| |
Collapse
|
41
|
Extracervical Approaches to Thyroid Surgery: Evolution and Review. Minim Invasive Surg 2019; 2019:5961690. [PMID: 31531238 PMCID: PMC6719267 DOI: 10.1155/2019/5961690] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/10/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.
Collapse
|
42
|
Jamikorn T, Anuwong A. Transoral Endoscopic Thyroidectomy (TOETVA). CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Transoral endoscopic thyroid surgery in a Korean population. Surg Endosc 2019; 33:2104-2113. [DOI: 10.1007/s00464-018-6481-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
|
44
|
Kim HK, Park D, Kim HY. Robotic transoral thyroidectomy: Total thyroidectomy and ipsilateral central neck dissection with da Vinci Xi Surgical System. Head Neck 2019; 41:1536-1540. [PMID: 30758104 DOI: 10.1002/hed.25661] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/18/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Transoral approach for thyroidectomy draws attention recently among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. The aim of this study is to demonstrate the details and the steps of transoral robotic thyroidectomy. METHODS We made three incisions in the gingival-buccal sulcus for three 8-mm intraoral ports: one inverted U-shaped 1-cm midline incision approximately 2 cm above the frenulum, and two 0.5-cm lateral incisions near the commissure of lips. An additional 8-mm axilla port was inserted for countertraction and later drain insertion. RESULTS Right thyroid lobectomy, ipsilateral central neck dissection, and left thyroid lobectomy were performed with preserving recurrent laryngeal nerves and parathyroid glands. There was no development of transient or permanent hypoparathyroidism, vocal cord palsy, postoperative bleeding, or surgical site infection. CONCLUSION Transoral robotic total thyroidectomy and ipsilateral central neck dissection using the da Vinci Xi Surgical System are feasible and safe.
Collapse
Affiliation(s)
- Hong Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dawon Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
45
|
Russell JO, Razavi CR, Garstka ME, Chen LW, Vasiliou E, Kang SW, Tufano RP, Kandil E. Remote-Access Thyroidectomy: A Multi-Institutional North American Experience with Transaxillary, Robotic Facelift, and Transoral Endoscopic Vestibular Approaches. J Am Coll Surg 2018; 228:516-522. [PMID: 30586640 DOI: 10.1016/j.jamcollsurg.2018.12.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many remote-access approaches (RAAs) to the thyroid have been described to circumvent anterior neck scarring, including the transaxillary, robotic facelift, and transoral endoscopic vestibular approaches. These techniques have been popularized in Asia, but adoption has been slow in North America. We aimed to examine multi-institutional North American outcomes with RAA thyroidectomy in the context of these institutions' transcervical approach (TCA) outcomes. STUDY DESIGN Cases of lobectomy and total thyroidectomy via transaxillary, robotic facelift, and transoral endoscopic vestibular approaches were reviewed. Demographic characteristics, outcomes, and complications were compared with the same measures in patients undergoing lobectomy and total thyroidectomy via TCA by the primary RAA surgeons at each institution. Patients who underwent parathyroidectomy or other concomitant neck dissection procedures were excluded. RESULTS Two hundred and sixteen RAA thyroidectomies were attempted (92 transoral endoscopic vestibular approaches, 70 transaxillary, and 54 robotic facelift) and 410 TCA thyroidectomies were performed. There was no difference in mean index nodule sizes between RAA (2.8 ± 1.6 cm) and TCA (2.9 ± 1.9 cm) cohorts (p = 0.72). Median operative times for lobectomy were 146 minutes (range 60 to 343 minutes) and 90 minutes (range 25 to 247 minutes) for the RAA and TCA cohorts, respectively (p < 0.0001). Median operative time for total thyroidectomy was 170 minutes (range 100 to 398 minutes) vs 126.5 minutes (range 51 to 260 minutes) for the RAA and TCA cohorts, respectively (p < 0.0001). There was no difference in the rates of permanent recurrent laryngeal nerve injury between the RAA (0 of 216 [0%]) and TCA (0 of 410 [0%]) cohorts (p = 0.99). CONCLUSIONS Remote-access approach thyroidectomy can be performed in a select North American patient population with outcomes comparable with TCA.
Collapse
Affiliation(s)
- Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Christopher R Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meghan E Garstka
- Division of Endocrine Surgery, Department of Surgery, Tulane University Medical Center, New Orleans, LA
| | - Lena W Chen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elya Vasiliou
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sang-Wook Kang
- Division of Endocrine Surgery, Department of Surgery, Tulane University Medical Center, New Orleans, LA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emad Kandil
- Division of Endocrine Surgery, Department of Surgery, Tulane University Medical Center, New Orleans, LA
| |
Collapse
|
46
|
Abstract
Introduction: Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and retroauricular approaches in pediatric patients. Case Presentation: We conducted a retrospective review of pediatric patients who underwent robot-assisted neck surgery by a single surgeon between April 2010 and May 2017. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated. Management and Outcomes: Nine surgeries in 7 female patients were reviewed (mean age, 16.0 ± 1.58 years; mean body mass index, 22.5 ± 0.75). Two thyroid lobectomies, 2 complete thyroidectomies, 1 subtotal thyroidectomy, 1 thyroid lobectomy with thymectomy, 2 subtotal parathyroidectomies with thymectomy, and 1 dermoid cyst excision were performed. Two surgeries with the retroauricular approach had a mean surgical time of 142.0 ± 6.13 minutes. Seven surgeries with the transaxillary approach had a mean surgical time of 146.1 ± 21.01 minutes. There were no reported conversions, permanent vocal cord paralysis, permanent hypoparathyroidism, hematoma, or seroma. There was 1 case (11%) of temporary shoulder hypoesthesia and 2 cases of temporary vocal cord paresis (22%). Discussion: This series on robot-assisted neck surgeries in children describes procedures performed with robotic transaxillary and retroauricular approaches. In the hands of a high-volume surgeon the techniques are feasible and safe options for operations in the neck in a select group of pediatric patients.
Collapse
Affiliation(s)
- Eric L Wu
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Meghan E Garstka
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Sang-Wook Kang
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Emad Kandil
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| |
Collapse
|
47
|
Tae K, Lee DW, Song CM, Ji YB, Park JH, Kim DS, Tufano RP. Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures. Head Neck 2018; 41:730-738. [DOI: 10.1002/hed.25426] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Jung Hwan Park
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Sun Kim
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| |
Collapse
|
48
|
Lee D, Kong HJ, Kim D, Yi JW, Chai YJ, Lee KE, Kim HC. Preliminary study on application of augmented reality visualization in robotic thyroid surgery. Ann Surg Treat Res 2018; 95:297-302. [PMID: 30505820 PMCID: PMC6255749 DOI: 10.4174/astr.2018.95.6.297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/01/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose Increased robotic surgery is attended by increased reports of complications, largely due to limited operative view and lack of tactile sense. These kinds of obstacles, which seldom occur in open surgery, are challenging for beginner surgeons. To enhance robotic surgery safety, we created an augmented reality (AR) model of the organs around the thyroid glands, and tested the AR model applicability in robotic thyroidectomy. Methods We created AR images of the thyroid gland, common carotid arteries, trachea, and esophagus using preoperative CT images of a thyroid carcinoma patient. For a preliminary test, we overlaid the AR images on a 3-dimensional printed model at five different angles and evaluated its accuracy using Dice similarity coefficient. We then overlaid the AR images on the real-time operative images during robotic thyroidectomy. Results The Dice similarity coefficients ranged from 0.984 to 0.9908, and the mean of the five different angles was 0.987. During the entire process of robotic thyroidectomy, the AR images were successfully overlaid on the real-time operative images using manual registration. Conclusion We successfully demonstrated the use of AR on the operative field during robotic thyroidectomy. Although there are currently limitations, the use of AR in robotic surgery will become more practical as the technology advances and may contribute to the enhancement of surgical safety.
Collapse
Affiliation(s)
- Dongheon Lee
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Donguk Kim
- Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Yi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
Tesseroli MAS, Spagnol M, Sanabria Á. Tireoidectomia endoscópica transoral por acesso vestibular (TOETVA): experiência inicial no Brasil. Rev Col Bras Cir 2018; 45:e1951. [DOI: 10.1590/0100-6991e-20181951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
RESUMO Objetivo: apresentar a experiência inicial no Brasil com a tireoidectomia transoral endoscópica por abordagem vestibular (TOETVA). Métodos: estudo prospectivo de pacientes submetidos à TOETVA no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Regional do Oeste, Chapecó, Santa Catarina. Foram candidatos para o estudo os pacientes entre 18 e 65 anos de idade, ASA I e II, com volume glandular de até 35cm3e nódulos de até de 4cm. Dados dos pacientes, dos nódulos, tempo cirúrgico, complicações, e tempo de internação foram registrados. Resultados: nove pacientes foram operados entre maio de 2017 e abril de 2018. Todos eram mulheres, com idades entre 33 e 64 anos. O tamanho do nódulo variou de 1cm a 4cm. Dois pacientes eram portadores de neoplasia maligna e a tireoidectomia total foi feita em oito casos. Sete pacientes tiveram uma internação de apenas um dia. Um paciente sofreu uma complicação menor na pele, mas não ocorreram lesões dos nervos laríngeos recorrentes ou hipoparatireoidismo definitivo. Conclusão: a TOETVA é uma técnica segura para pacientes bem selecionados, com condições favoráveis e com especial preocupação com resultados estéticos.
Collapse
Affiliation(s)
| | - Mauricio Spagnol
- Universidade Comunitária da Região de Chapecó (UNOCHAPECÓ), Brasil
| | | |
Collapse
|
50
|
Sukato DC, Ballard DP, Abramowitz JM, Rosenfeld RM, Mlot S. Robotic versus conventional neck dissection: A systematic review and meta-analysis. Laryngoscope 2018; 129:1587-1596. [DOI: 10.1002/lary.27533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Daniel P. Ballard
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Jason M. Abramowitz
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard M. Rosenfeld
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Stefan Mlot
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| |
Collapse
|