1
|
Chen K, Zhang J, Beeraka NM, Lu P. Robotic nipple sparing mastectomy and immediate breast reconstruction: significant attempts with the latissimus dorsi muscle without island flap. Minerva Surg 2024; 79:411-418. [PMID: 38757888 DOI: 10.23736/s2724-5691.24.10244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study presents preliminary results of robot-assisted nipple-sparing immediate breast reconstruction (R-NSMIBR) with gel implant combined with latissimus dorsi muscle flap without island flap and validation of the safety and utility of this novel surgical modality. METHODS Records pertinent to R-NSMIBR with gel implants combined with latissimus dorsi muscle flap surgery for breast reconstruction between September 2022 and May 2023 were examined. A total of 13 patients who underwent R-NSMIBR were analyzed, nine of which were performed without skin island. RESULTS We divided the patients with and without skin islands into two groups and recorded the operation time and bleeding respectively. The mean total operative time for R-NSMIBR was 436.5±56.88 minutes and 355.75±69.68 minutes. As experience in learning increased, time required to create the operating space and position the robotic arm decreased significantly. Not creating an island of skin also saves a great deal of surgical time. Average total blood loss was 37.5±6.45 mL and 26.25±7.5 mL. No cases of nipple-areolar complex necrosis or perioperative complications or no local recurrences were reported. There were no local recurrences or deaths that occurred during a mean follow-up period of 3±1 months. CONCLUSIONS All the patients expressed satisfaction with the aesthetic outcome following surgery. There were no significant differences between two groups. This surgical method shows promise for future promotion in the field.
Collapse
Affiliation(s)
- Kuo Chen
- Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Narasimha M Beeraka
- Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Chiyyedu, India
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pengwei Lu
- Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China -
| |
Collapse
|
2
|
Bae HL, Wong JSH, Kim SJ, Jung Y, Choi JB, Kwak J, Yu HW, Chai YJ, Choi JY, Lee KE. Surgical outcomes of robotic thyroidectomy for thyroid tumors over 4 cm via the bilateral axillo-breast approach. Sci Rep 2024; 14:11646. [PMID: 38773181 PMCID: PMC11109269 DOI: 10.1038/s41598-024-62021-2] [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: 10/22/2023] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
The study investigated the feasibility of robotic bilateral axillo-breast approach (BABA) thyroidectomy for patients with thyroid tumors larger than 4 cm. BABA thyroidectomy has previously shown safety and effectiveness for thyroid surgeries but lacked extensive data on its application to larger tumors. Between October 2008 and August 2022, there were 74 patients underwent robotic BABA thyroidectomy due to thyroid nodules exceeding 4 cm in size. The mean patient age was 40.3 years. Fine needle aspiration results classified the tumors as benign (50.0%), atypia of undetermined significance (27.0%), follicular neoplasm (16.2%), suspicious for malignancy/malignancy (5.4%), or lymphoma (1.4%). The average tumor size was 4.9 cm, with the majority (85.1%) undergoing thyroid lobectomy, and the rest (14.9%) receiving total thyroidectomy. The mean total operation time was 178.4 min for lobectomy and 207.3 min for total thyroidectomy. Transient vocal cord palsy (VCP) was found in 3 patients (4.1%), and there was no permanent VCP. Among patients who underwent total thyroidectomy, transient hypoparathyroidism was observed in three (27.2%), and permanent hypoparathyroidism was observed in one (9.1%). There were no cases of open conversion, tumor spillage, bleeding, flap injury, or tumor recurrence. In conclusion, robotic BABA thyroidectomy may be a safe treatment option for large-sized thyroid tumors that carries no significant increase in complication rates.
Collapse
Affiliation(s)
- Hye Lim Bae
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, South Korea
| | | | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, South Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Younghoon Jung
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, South Korea
| | - Jae Bong Choi
- Department of Surgery, Gachon University Gil Medical Center, Incheon, South Korea
| | - JungHak Kwak
- Division of Endocrine Surgery, Department of Surgery, Gibbeum Hospital, Seoul, South Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, South Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Medical Big Data Research Center, Institute of Medical and Biological Engineering, Seoul National University, Seoul, South Korea
| |
Collapse
|
3
|
Lee JH, Kwon H. An institutional experience of intraoperative neurophysiological monitoring application in robotic thyroidectomy: a retrospective case-control study. Ann Surg Treat Res 2024; 106:243-247. [PMID: 38725805 PMCID: PMC11076952 DOI: 10.4174/astr.2024.106.5.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose Intraoperative neurophysiological monitoring (IONM) has been introduced in thyroid surgery to prevent injury of the recurrent laryngeal nerve (RLN). However, its effectiveness remains controversial in robotic thyroidectomy (RT). This study aimed to compare the surgical outcome of RT in patients with and without the application of IONM. Methods This retrospective case-control study included 100 patients who underwent total thyroidectomy via robotic bilateral axillo-breast approach in a tertiary center. A study group of 50 patients who had IONM during RT was compared to a control group of 50 patients who underwent RT with nerve visualization alone. Results The sex ratio (4:45 vs. 7:43, P = 0.538), mean age (39.3 ± 7.1 years vs. 37.5 ± 10.4 years, P = 0.304), and body mass index (23.1 ± 2.6 kg/m2 vs. 22.2 ± 3.9 kg/m2, P = 0.215) were comparable between the IONM and control groups. Pathologic features including tumor size (0.8 cm vs. 0.9 cm, P = 0.283), extrathyroidal extension (58.0% vs. 24.0%, P = 0.316), lymph node metastasis (30% vs. 34%, P = 0.668), and number of lymph nodes (5.3 vs. 5.3, P = 0.668) showed no differences. There was no permanent RLN palsy, postoperative bleeding, and wound complications. Transient hypoparathyroidism was observed in 12 (24.0%) and 14 (28.0%), permanent hypoparathyroidism in 0 (0%) and 1 (2.0%), and transient RLN palsy was observed in 3 (6.0%) and 3 (6.0%), respectively. Conclusion We did not demonstrate a clear advantage of IONM in RT. Controversies regarding the effectiveness of IONM is not closed.
Collapse
Affiliation(s)
- Joon-Hyop Lee
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, Seoul, Korea
| |
Collapse
|
4
|
Wang SH, Chao WP, Lo TY, Ng SC, Chen YH. Comparison of Surgical Outcomes of Transoral Versus Open Thyroidectomy for Graves Disease. Surg Laparosc Endosc Percutan Tech 2024; 34:150-155. [PMID: 38359355 DOI: 10.1097/sle.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe alternative to thyroidectomy for thyroid goiter and provides the benefit of being scarless. However, the data on the use of TOETVA in patients with Graves disease are limited. This retrospective study compared the outcomes of Graves disease patients who underwent TOETVA versus those who underwent open thyroidectomy (OT). MATERIALS AND METHODS Patients with Graves disease who received TOETVA or OT for bilateral total thyroidectomy between September 2017 and October 2022 were included. Patient demographics and surgical outcomes, including operation time, blood loss, length of stay, and complications, were compared. RESULTS There were 15 patients in each group. The mean age in the TOETVA group was 35.80±8.13 years, which was significantly younger than that in the OT group, which was 51.53±14.22 years. Females predominated in both groups. The other demographic characteristics were similar in both groups. The operation time and intraoperative blood loss were also comparable. The postoperative stay and complications, including hypoparathyroidism, recurrent laryngeal nerve injury, surgical site infection, postoperative hemorrhage, and recurrence of hyperthyroidism, were not different between the 2 groups. There were 11 patients in the TOETVA group and 10 in the OT group who had thyroglobulin levels <0.1 ng/dL, indicating the completeness of total thyroidectomy in the 2 groups. There was no conversion of TOETVA to an open procedure. CONCLUSIONS For carefully selected Graves patients, TOETVA offers a safe, scarless, and feasible alternative to conventional open thyroidectomy.
Collapse
Affiliation(s)
- Suo-Hsien Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wu-Po Chao
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ta-You Lo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taiwan
| | - Soh-Ching Ng
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taiwan
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| |
Collapse
|
5
|
Lee JK, Kong Y, Choi JB, Kim W, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. TSH receptor antibody as a predictor of difficult robotic thyroidectomy in patients with Graves' disease. J Robot Surg 2024; 18:108. [PMID: 38436742 PMCID: PMC10912279 DOI: 10.1007/s11701-024-01869-y] [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: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Thyroidectomy in Graves' disease can be challenging due to greater thyroid size and vascularity. While thyroid stimulating hormone receptor antibody (TRAb) level is associated with disease severity and thyroid vascularity, its impact on operative outcomes remains unclear. This study aimed to compare challenging factors for robotic thyroidectomy (RT) and open thyroidectomy (OT) in Graves' disease patients, including TRAb as a predictive factor for difficult thyroidectomy. This retrospective study included Graves' disease patients who underwent total thyroidectomy between September 2013 and January 2023. The clinical characteristics and operative outcomes were compared between patients who received OT and bilateral axillo-breast approach RT. Factors affecting operation time and estimated blood loss (EBL) were evaluated in both groups using regression analyses. A total of 85 patients received either OT (n = 48) or RT (n = 37). Median thyroid volumes in the OT and RT groups were 72.4 g and 57.6 g, respectively. Operation time was affected by thyroid volume in both groups. Additionally, higher thyroid hormone levels and bilateral central neck node dissection prolonged operation time in the RT group. EBL was marginally associated with thyroid volume in the OT group. However, in the RT group, TRAb level was independently associated with greater EBL (p = 0.04), while no significant association was found with thyroid volume. Predictive factors for difficult thyroidectomy differed by operation approaches. TRAb significantly predicted intraoperative bleeding in RT, while this association was absent in OT. Caution is warranted when performing RT on Graves' disease patients with high TRAb levels.
Collapse
Affiliation(s)
- Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoon Kong
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Bong Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
6
|
Sialakis C, Frantzana A, Iliadis C, Ouzounakis P, Antoniou Sialaki P, Kourkouta L. Comparison of Robotic Versus Conventional Open Thyroidectomy for Recurrent Laryngeal Nerve Safety: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53860. [PMID: 38465121 PMCID: PMC10924667 DOI: 10.7759/cureus.53860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
This review aims to investigate the safety of recurrent laryngeal nerve (RLN) by comparing robotic thyroidectomy (RT) versus open thyroidectomy (OT) in Western and Asian populations. Two main outcomes of this review were (1) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication in each surgical procedure and (2) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication between studies conducted in USA/Europe and Asia. We searched relevant literature in electronic databases such as PubMed, MEDLINE, Cochrane CENTRAL, ScienceDirect, and Cumulative Index to Nursing & Allied Health (CINAHL) up to September 2022. Further research was performed during January 2024 in the Scopus database. Two primary outcomes were set: transient RLN palsy and permanent RLN palsy, comparing RT and OT. In this review, 18 non-randomized studies were included. A statistically significant difference between robotic and conventional OT was not observed either in transient RLN or in permanent RLN palsy. The odds ratio (OR) for the overall comparison of transient RLN palsy was 1.18, and the 95% confidence interval (95% CI) was 0.80-1.74. The subgroup analysis for transient RLN palsy between USA/Europe studies was OR 1.28, and the 95% CI was 0.64-2.58. The subgroup analysis for transient RLN palsy between Asian studies was OR 1.14, and the 95% CI was 0.72-1.82. The OR for the overall comparison of permanent RLN palsy was OR 0.90, and the 95% CI was 0.38-2.15. The subgroup analysis for permanent RLN palsy between USA/Europe studies was OR 0.45, and the 95% CI was 0.07-2.97. The subgroup analysis for permanent RLN palsy between Asian studies was OR 1.13, and the 95% CI was 0.42-3.05. Heterogeneity I2 was 0% in all outcomes. The Mantel-Haenszel method fixed effect was used. First, RT and open conventional thyroidectomy have comparable safety for RLN, although the analysis showed no statistically significant results. Second, no statistically significant results were found for RLN safety in either USA/Europe or Asian studies. Considering that there is not a statistically significant difference between the two approaches for RLN safety, and due to the limited number of studies from Western countries, the results should be considered with caution. Important factors such as the patient's body characteristics, the existing thyroid pathology, and the surgical approach should be kept in mind. More comparable studies are needed on the Western population.
Collapse
Affiliation(s)
| | - Aikaterini Frantzana
- Epidemiology and Public Health, George Papanikolaou General Hospital of Thessaloniki, Thessaloniki, GRC
- Public Health, European University Cyprus, Nicosia, CYP
| | - Christos Iliadis
- Nuclear Medicine, Private Diagnostic Health Center, Thessaloniki, GRC
| | | | | | | |
Collapse
|
7
|
Lee JK, Choi JH, Kim W, Kwak J, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. Bilateral axillo-breast approach robotic thyroidectomy in pediatric patients with thyroid disease and cancer. Endocrine 2023; 81:532-539. [PMID: 37171524 DOI: 10.1007/s12020-023-03372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Robotic thyroid surgeries have cosmetic advantages over open surgeries, which are especially important in pediatric patients due to social stigmas from neck scars. The present study describes outcomes in a series of children who underwent bilateral axillo-breast approach (BABA) robotic thyroidectomy. METHODS Pediatric patients aged ≤18 years who underwent BABA robotic thyroidectomy between 2014 and 2022 were retrospectively reviewed. Their clinical characteristics and surgical outcomes were evaluated. Surgical completeness was determined by comparing the number of retrieved lymph nodes per compartment to previously reported lymph node quantification. RESULTS This study included 26 pediatric patients of mean age 15.5 years (range, 5-18 years). Of these 26 patients, 21 (80.8%) had thyroid cancer, with 9 (42.9%) having aggressive tumor pathology. The mean operation time was 157.3 min. No patient needed open conversion. Five patients (19.2%) experienced complications including transient hypoparathyroidism (n = 5), permanent hypoparathyroidism (n = 2), and chyle leakage (n = 1), but none experienced vocal cord palsy. The mean numbers of retrieved lymph nodes at levels IIa, III, IV, Vb, and VI were 3.2, 4.1, 5.6, 1.0, and 9.7, respectively, numbers comparable with the known quantification except for level II, as IIb dissection was omitted in our series. CONCLUSION BABA robotic thyroidectomy is safe and effective in pediatric patients with thyroid diseases. Most complications were minor and transient, with the operation time similar to robotic thyroidectomy in adults. Surgical completeness was also satisfactory. Robotic thyroidectomy can be considered a surgical option, regardless of patient age or diagnosis.
Collapse
Affiliation(s)
- Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| |
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
|
Godi P, Chand G. Letter to Editor: A Time Trend Analysis of 5000 Robotic Thyroidectomies via Bilateral Axillo-Breast Approach. World J Surg 2023; 47:2085. [PMID: 37310440 DOI: 10.1007/s00268-023-07007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Prathyusha Godi
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India
| | - Gyan Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
| |
Collapse
|
10
|
A Time Trend Analysis of 5,000 Robotic Thyroidectomies via Bilateral Axillo-Breast Approach. World J Surg 2023; 47:403-411. [PMID: 36525062 DOI: 10.1007/s00268-022-06836-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to investigate the time trends of surgical outcomes in patients who underwent bilateral axillo-breast approach robotic thyroidectomy (BABA RT) over the last 14 years. METHODS From February 2008 to September 2021, we conducted a retrospective medical chart review of 5,011 consecutive patients who underwent BABA RT at three Seoul National University-affiliated hospitals. The patients were divided into three groups based on the main model of the da Vinci robotic surgical system to evaluate trends in surgical treatment strategies and outcomes after BABA RT. RESULTS Of the 5,011 patients (4,706 malignant and 305 benign), the most common histological subtype was papillary thyroid carcinoma (n = 4,584; 97.4%). The mean tumor size significantly increased from 0.8 cm to 1.2 cm (p < 0.05). The mean numbers of metastatic and harvested lymph nodes from the central neck dissection and the lateral neck dissection showed a significant difference and tendency to increase (from 0.9 to 1.6, 4.7 to 6.2, p < 0.05, and from 0.6 to 3.9, 5.3 to 17.9, p < 0.05), respectively, throughout the study period. Permanent hypoparathyroidism decreased from 3.4 to 2.9%. The rate of transient and permanent vocal cord palsy decreased from 15.2 to 2.7% and from 0.7 to 0.2%, respectively. CONCLUSION With advancements in robotic surgical systems and improvements in the BABA RT technique, surgical indications have expanded to include more advanced thyroid diseases, and surgical outcomes have improved over the last 14 years.
Collapse
|
11
|
Cohen O, Ronen O, Khafif A, Rodrigo JP, Simo R, Pace-Asciak P, Randolph G, Mikkelsen LH, Kowalski LP, Olsen KD, Sanabria A, Tufano RP, Babighian S, Shaha AR, Zafereo M, Ferlito A. Revisiting the role of surgery in the treatment of Graves' disease. Clin Endocrinol (Oxf) 2022; 96:747-757. [PMID: 34954838 DOI: 10.1111/cen.14653] [Citation(s) in RCA: 7] [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: 08/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/06/2023]
Abstract
Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.
Collapse
Affiliation(s)
- Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel
| | - Juan P Rodrigo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, Oviedo, Spain
| | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA
| | - Lauge H Mikkelsen
- Department of Pathology, Eye Pathology Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, AC Camargo Cancer Center, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello-Clínica Las Vegas-Quirón, Medellín, Colombia
| | - Ralph P Tufano
- Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Madison, USA
| | - Silvia Babighian
- Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mark Zafereo
- Department of Head & Neck Surgery, Anderson Cancer Center, Houston, Texas, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
12
|
Robot-Assisted Minimally Invasive Breast Surgery: Recent Evidence with Comparative Clinical Outcomes. J Clin Med 2022; 11:jcm11071827. [PMID: 35407434 PMCID: PMC8999956 DOI: 10.3390/jcm11071827] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
In recent times, robot-assisted surgery has been prominently gaining pace to minimize overall postsurgical complications with minimal traumatization, due to technical advancements in telerobotics and ergonomics. The aim of this review is to explore the efficiency of robot-assisted systems for executing breast surgeries, including microsurgeries, direct-to-implant breast reconstruction, deep inferior epigastric perforators-based surgery, latissimus dorsi breast reconstruction, and nipple-sparing mastectomy. Robot-assisted surgery systems are efficient due to 3D-based visualization, dexterity, and range of motion while executing breast surgery. The review describes the comparative efficiency of robot-assisted surgery in relation to conventional or open surgery, in terms of clinical outcomes, morbidity rates, and overall postsurgical complication rates. Potential cost-effective barriers and technical skills were also delineated as the major limitations associated with these systems in the clinical sector. Furthermore, instrument articulation of robot-assisted surgical systems (for example, da Vinci systems) can enable high accuracy and precision surgery due to its promising ability to mitigate tremors at the time of surgery, and shortened learning curve, making it more beneficial than other open surgery procedures.
Collapse
|
13
|
Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves' Disease: A Retrospective Cohort Study. World J Surg 2022; 46:1107-1113. [PMID: 35015120 DOI: 10.1007/s00268-021-06430-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the increase in experience and understanding of robotic thyroidectomy, its application for Graves' disease (GD) remains controversial. This study aimed to assess the safety and feasibility of robotic transaxillary thyroidectomy (RTT) for GD in comparison with the conventional open thyroidectomy (open group: OG) approach. METHODS A total of 192 patients who underwent surgical resection for GD were retrospectively reviewed. Among them, 51 patients underwent RTT and the remaining 141 patients were in the conventional OG. RESULTS All robotic operations were performed successfully without open conversion. Patients who underwent RTT were significantly younger (P < 0.001) and predominantly of the female sex. Operative time was longer for RTT than for the OG (182.5 ± 58.1 vs. 112.0 ± 29.5; P < 0.001). The mean intraoperative blood loss was not statistically different between RTT and the OG (113.3 ± 161.6 vs. 95.3 ± 209.1, P = 0.223). The mean weight of the resected thyroid was reduced in those who underwent RTT compared with open thyroidectomy (P = 0.033). The overall complication rate for RTT and open thyroidectomy was not significantly different (33.3% vs. 22.7%, P = 0.135). In RTT, the most common complication was transient hypocalcemia (21%). Permanent hypocalcemia and recurrent laryngeal nerve injury occurred in only one patient in each group. The weight of the resected thyroid was not related to the incidence of complications in patients receiving RTT. CONCLUSIONS Considering excellent cosmesis, findings of this study support the safety and feasibility of RTT. Nevertheless, it should be performed by expert surgeons with extensive robotic surgery experience.
Collapse
|
14
|
Maurer E, Vorländer C, Zielke A, Dotzenrath C, von Frankenberg M, Köhler H, Lorenz K, Weber T, Jähne J, Hammer A, Böttcher KA, Schwarz K, Klinger C, Buhr HJ, Bartsch DK. Short-Term Outcomes of Surgery for Graves' Disease in Germany. J Clin Med 2020; 9:jcm9124014. [PMID: 33322553 PMCID: PMC7763951 DOI: 10.3390/jcm9124014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical treatment of Graves' disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. METHODS Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student's t-test or Fisher's exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. RESULTS A total of 1808 patients with GD with a median age of 44 (range 14-85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. CONCLUSION Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.
Collapse
Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
- Correspondence:
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt/Main, 60318 Frankfurt am Main, Germany;
| | - Andreas Zielke
- Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Cornelia Dotzenrath
- Department of Endocrine Surgery, Helios Universityhospital Wuppertal, 42283 Wuppertal, Germany;
| | | | - Hinrich Köhler
- Department of General Surgery, Herzogin Elisabeth Hospital Braunschweig, 38124 Braunschweig, Germany;
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, 06120 Halle, Germany;
| | - Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, 55131 Mainz, Germany;
| | - Joachim Jähne
- Department of General and Visceral Surgery, Diakovere Henriettenstift Hannover, 30171 Hannover, Germany;
| | - Antonia Hammer
- Department of Endocrine Surgery, DKD Helios Clinic Wiesbaden, 65191 Wiesbaden, Germany;
| | - Knut A. Böttcher
- Department of General and Visceral Surgery, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Katharina Schwarz
- Department of Endocrine Surgery, Lukas Hospital GmbH Neuss, 41464 Neuss, Germany;
| | - Carsten Klinger
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Heinz J. Buhr
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
| |
Collapse
|
15
|
Robotic surgery versus open surgery for thyroid neoplasms: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2020; 146:3297-3312. [PMID: 33108513 DOI: 10.1007/s00432-020-03418-0] [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] [Received: 05/05/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included. RESULTS In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery. CONCLUSIONS Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.
Collapse
|
16
|
Liu P, Zhang Y, Qi X, Liu H, Du J, Liu J, Liu J, Fu W, Zhang Y, Jiang J, Fan L. Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon. J Cancer 2019; 10:3851-3859. [PMID: 31333802 PMCID: PMC6636286 DOI: 10.7150/jca.31463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/04/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the efficacy and safety of da Vinci robot-assisted thyroidectomy via an unilateral axilla-bilateral areola (UABA) approach. Methods: The clinical data of 500 patients undergoing robotic thyroidectomy via an UABA approach from July 2014 to April 2018 were retrospectively analyzed. All 500 patients were operated on by the same surgeon and divided into two groups by the time sequence. The efficacy and complications were compared between the two groups. Results: Robotic thyroidectomy via an UABA approach was performed successfully in 500 cases, including 196 cases of benign thyroid diseases with a lesion diameter of 3.1 ± 1.3 cm (0.4 - 8.2 cm) and 304 cases of thyroid cancer with a tumor diameter of 1.2 ± 0.7 cm (0.4 - 4.4 cm). Surgical procedures included unilateral lobectomy and total thyroidectomy with or without central lymph node dissection. Among the 500 patients, 9 (1.8%) had transient recurrent laryngeal nerve injury, 1 (0.2%) had permanent unilateral recurrent laryngeal nerve injury, 12 (2.4%) had subcutaneous hemorrhage of the trajectory area, and 6 (1.2%) had subcutaneous infection of the trajectory area after surgery. Among 239 thyroid cancer patients undergoing total thyroidectomy, 45 (18.8%) had transient hypoparathyroidism and 5 (2.1%) had permanent hypoparathyroidism. The incidence of permanent hypoparathyroidism was 1.9% (4/212) among the patients undergoing total thyroidectomy plus unilateral central lymph node dissection, and 3.7% (1/27) among the patients undergoing total thyroidectomy plus bilateral central lymph node dissection. During the follow-up of median 17 months, all patients were satisfied with postoperative appearance of the neck and no structural recurrence or metastases occurred. There was no significant difference in efficacy between the two groups (P > 0.05), while the complication rate in phase 2 was significantly lower than that in phase 1 (P < 0.05) as the surgeon became more proficient in the UABA approach. Conclusion: Robotic thyroidectomy via an UABA approach is simple, safe, and minimally invasive, suitable for radical resection of large benign tumors and early thyroid cancer and central lymph node dissection.
Collapse
Affiliation(s)
- Pengfei Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
- Department of Breast Surgery, First Affiliated Hospital, Hunan Traditional Chinese Medical College, Hunan Provence, China
| | - Ye Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaowei Qi
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Haoxi Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junze Du
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jing Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junlan Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenying Fu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jun Jiang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| |
Collapse
|
17
|
Harsløf T, Rolighed L, Rejnmark L. Huge variations in definition and reported incidence of postsurgical hypoparathyroidism: a systematic review. Endocrine 2019; 64:176-183. [PMID: 30788669 DOI: 10.1007/s12020-019-01858-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The reported incidence of post surgical hypoparathyroidism (HypoPT) varies greatly. Previous research suggests that the definition of HypoPT is not consistent in the literature. We therefore conducted a systematic review to investigate how HypoPT is defined and whether this definition, as well as the selected threshold for hypocalcemia affects the incidence. METHODS Using a predefined search string we identified all articles in PubMed reporting on the incidence of postsurgical HypoPT from 1st January 2010 to January 2017. RESULTS We identified 89 articles that employed 20 different definition of HypoPT. The incidence of HypoPT varied from 0.0% to 20.2%. The definitions were not associated with incidence of HypoPT. Use of prophylactic post-operative calcium supplements, however decreased the risk of HypoPT (p = 0.03), and there was a trend towards a lower risk of HypoPT when using a definition of hypocalcemia below lower limit of the reference range (p = 0.09). CONCLUSION The large number of definitions of HypoPT, as well as the huge variation in incidence point to a problem suggests that the awareness of HypoPT should be raised. Use of prophylactic post-operative calcium supplements may decrease risk of HypoPT. This, however, may be due to reverse causality as awareness of the risk of HypoPT may promote the use of calcium supplementation.
Collapse
Affiliation(s)
- Torben Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Lars Rolighed
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
18
|
Kim H, Kwon H, Lim W, Moon BI, Paik NS. Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery. J Clin Med 2019; 8:jcm8030402. [PMID: 30909509 PMCID: PMC6463185 DOI: 10.3390/jcm8030402] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.
Collapse
Affiliation(s)
- HyunGoo Kim
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Woosung Lim
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| |
Collapse
|
19
|
Mercader Cidoncha E, Amunategui Prats I, Escat Cortés JL, Grao Torrente I, Suh H. Scarless neck thyroidectomy using bilateral axillo-breast approach: Initial impressions after introduction in a specialized unit and a review of the literature. Cir Esp 2019; 97:81-88. [PMID: 30691690 DOI: 10.1016/j.ciresp.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The extracervical approach for thyroidectomy remains widely unknown in our country. Its main aim is to avoid a cervical scar while maintaining the same safety profile of conventional thyroidectomy. The objective is to communicate our experience after the first 15 cases using the endoscopic bilateral axillo-breast approach (BABA) and to review critical points described in literature. METHODS Between June 2017 and June 2018, 15 endoscopic thyroidectomies were performed using the BABA extracervical approach, locating incisions in axillary folds and areolar borders. Indications were benign goiter and suspicious nodule (Bethesda 3 and 4). RESULTS All 15 cases (12 patients) were treated using the extracervical endoscopic technique. We performed 5 total thyroidectomies, 7 hemithyroidectomies and 3 completion thyroidectomies. Mean surgical time for total thyroidectomy was 285minutes and 210minutes for hemithyroidectomy. The average hospital stay was 1.67days. With a mean follow-up of 7.73months, rates of transient and definitive hypoparathyroidism were 37% and 0%, and transient recurrent nerve palsy occurred in one case. Anterior chest paraesthesia rate was 80%, which were mild and resolved within the first month. The degree of cosmetic satisfaction is very high. CONCLUSION Our experience with endoscopic bilateral axillo-breast approach thyroidectomy is short but satisfactory. It is a reproducible procedure that requires extensive experience in endocrine and endoscopic surgery. Extracervical approaches are an alternative for selected patients who are especially concerned about cervical scarring and are not intended to displace conventional thyroidectomy, which is the current gold standard. Our Scientific Society should explore these approaches to establish coherent indications and limitations.
Collapse
Affiliation(s)
- Enrique Mercader Cidoncha
- Sección de Cirugía Endocrino-Metabólica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España.
| | - Iñaki Amunategui Prats
- Sección de Cirugía Endocrino-Metabólica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - José Luis Escat Cortés
- Sección de Cirugía Endocrino-Metabólica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Irene Grao Torrente
- Sección de Cirugía Endocrino-Metabólica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Hyunsuk Suh
- Department of Surgery, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
20
|
Kwon H, Kim JK, Lim W, Moon BI, Paik NS. Increased risk of postoperative complications after total thyroidectomy with Graves' disease. Head Neck 2018; 41:281-285. [PMID: 30537006 DOI: 10.1002/hed.25484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The effect of Graves' disease on the risk of postoperative complications in patients undergoing total thyroidectomy is unclear. METHODS The incidence of recurrent laryngeal nerve (RLN) injury and hypoparathyroidism were analyzed between 165 patients with Graves' disease (GD group) and 1:1 matched patients with euthyroid states (control group). RESULTS The matched cohorts did not differ in age, sex, body mass index, pathologic diagnosis, and extent of operation. Excised thyroid weight was higher in the Graves' disease than in the control group (60.1 g vs 22.6 g; P < .001). Multivariate analysis showed that Graves' disease significantly increased risks of transient RLN injury (odds ratio [OR] = 4.7, 95% confidence interval [CI] = 1.5-15.5; P = .010) and transient hypoparathyroidism (OR = 2.8, 95% CI = 1.3-5.8; P = .007). Rates of permanent complications were comparable in the Graves' disease and control groups. CONCLUSIONS Graves' disease can be a predictive factor for postoperative RLN injury and hypoparathyroidism after total thyroidectomy.
Collapse
Affiliation(s)
- Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Jong-Kyu Kim
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Woosung Lim
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| |
Collapse
|
21
|
Shan L, Liu J. Meta-analysis Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy and Conventional Thyroidectomy. Surg Innov 2018; 26:112-123. [PMID: 30501575 DOI: 10.1177/1553350618817145] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective. Despite gaining popularity, bilateral axillo-breast approach robotic thyroidectomy (BABA RT) remains controversial. We performed a meta-analysis to evaluate the safety and effectiveness of BABA RT compared with open thyroidectomy (OT) in thyroid disease. Methods. A literature search was conducted using various databases, including PubMed, Web of Science, and Cochrane Library, up to February 2018. Outcomes of interest included patient characteristics, surgical outcomes, adverse events, complications, and surgical completeness. Results. A total of 11 publications including 2733 patients (1070 in the BABA RT and 1663 in the open group) were finally selected for the meta-analysis. BABA RT was associated with an equivalent complication rate, including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, and seroma, as well as surgical outcomes including tumor size, length of hospital stay, total drain amount, and pain score. BABA RT was also associated with an equivalent surgical completeness, including total dose of radioactive iodine, proportion of stimulated thyroglobulin (sTg) <1.0 ng/mL, and level of sTg. Moreover, BABA RT involved longer operative times (weighted mean difference [WMD] = 110.13; P < .00001), smaller number of retrieved lymph nodes(WMD = −1.26, P = .003), and more cost (WMD = 5811.18; P < .00001) compared with OT. Conclusions. BABA RT is safe and feasible and provides similar perioperative outcomes and complications when compared with OT. However, BABA RT was associated with longer operating time, fewer retrieved lymph nodes, and more cost. Randomized clinical trials with large samples and longer follow-up data are needed to more rigorously examine this effect.
Collapse
Affiliation(s)
- Liqun Shan
- Department of Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Jianing Liu
- Department of Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|
22
|
He QQ, Zhu J, Zhuang DY, Fan ZY, Zheng LM, Zhou P, Hou L, Yu F, Li YN, Xiao L, Dong XF, Ni GF. Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma. Chin Med J (Engl) 2017; 129:2160-6. [PMID: 27625085 PMCID: PMC5022334 DOI: 10.4103/0366-6999.189911] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA), compared with conventional open procedure in papillary thyroid microcarcinoma. METHODS One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n = 50 in each group). The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale (VAS), postoperative hospital stay time, complications, and numerical scoring system (NSS, used to assess cosmetic effect) were analyzed. RESULTS The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs. 90.7 ± 10.3 min, P < 0.05). The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs. 3.8 ± 1.2, P < 0.05) and NSS (8.9 ± 0.8 vs. 4.8 ± 1.7, P < 0.05). The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant (all P > 0.05). Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. CONCLUSIONS Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.
Collapse
Affiliation(s)
- Qing-Qing He
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Jian Zhu
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Da-Yong Zhuang
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Zi-Yi Fan
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Lu-Ming Zheng
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Peng Zhou
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Lei Hou
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Fang Yu
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Yan-Ning Li
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Lei Xiao
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Xue-Feng Dong
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| | - Gao-Feng Ni
- Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China
| |
Collapse
|
23
|
Liu SYW, Kim JS. Bilateral axillo-breast approach robotic thyroidectomy: review of evidences. Gland Surg 2017; 6:250-257. [PMID: 28713696 DOI: 10.21037/gs.2017.04.05] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The bilateral axillo-breast approach (BABA) is one of the most popular contemporary remote-access thyroidectomy techniques. While the initial experiences with BABA endoscopic thyroidectomy (ET) were associated with some technical challenges and safety concerns, many limitations of the technique could now be substantially overcome by BABA robotic thyroidectomy (RT). In this review, the current literature evidences of BABA RT were analyzed. Data regarding the patient selection, the learning curve, and the comparison with open thyroidectomy (OT) and BABA ET were examined. Careful case selection for BABA RT should be undertaken according to factors related to the patient and the thyroid pathology. The learning curve of BABA RT was about 40 cases. Comparing to OT, BABA RT was comparable to OT for the complication profiles and most perioperative outcomes. But it was associated with longer operative time, higher cost and possibly inferior oncological control with lower number of central lymph node (LN) retrieved. When compared to BABA ET, BABA RT was comparable for most perioperative outcomes except longer operative time and higher cost. Yet, BABA RT was superior to BABA ET for better oncological control. BABA RT is a safe and effective procedure for most benign thyroid conditions and low-risk differentiated thyroid cancers (DTC).
Collapse
Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|