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Hussein M, Issa PP, LaForteza A, Omar M, Magazine B, Abdelhady A, Hossam E, Shama M, Toraih E, Kandil E. Evaluating the Efficacy and Safety of Robotic Versus Conventional Completion Thyroidectomy: A 10-year Experience. Surg Innov 2024:15533506241273345. [PMID: 39099097 DOI: 10.1177/15533506241273345] [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: 08/06/2024]
Abstract
BACKGROUND Robotic thyroidectomy is gaining popularity, yet its role in completion thyroidectomy remains unclear. We aimed to compare robotic vs conventional completion thyroidectomy for thyroid nodules. METHODS This retrospective study analyzed patients undergoing completion thyroidectomy from 2010-2020, either by conventional open technique (n = 87) or a robotic remote-access approach (n = 44). Outcomes were compared between groups. RESULTS A total of 131 patients were included. The robotic cohort was younger (45.3 ± 14.0 vs 55.5 ± 14.5 years, P < 0.001) with a lower BMI (25.9 ± 5.5 vs 33.7 ± 7.8 kg/m2, P < 0.001). Operative time was longer for robotic procedures (139 min vs 99 min, P < 0.001). Hospital stay was shorter after robotic surgery, with 25% discharged the same day as compared to 5.7% in the open thyroidectomy cohort (P = 0.006). Overall rates of complication were comparable (P = 0.65). Transient recurrent laryngeal nerve palsy occurred in 4.6% of patients, which was similar between both cohorts (P = 0.66). CONCLUSION Robotic completion thyroidectomy appears safe and effective, achieving shorter hospitalization than conventional open approaches despite longer operative times. Appropriate patient selection and surgical technique optimization are key. Larger prospective studies should investigate costs and long-term patient-reported outcomes.
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Affiliation(s)
- Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Alexandra LaForteza
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Brandon Magazine
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ali Abdelhady
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eslam Hossam
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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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.
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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
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Sun H, Liu Z, Gao H, Kuang J, Chen X, Li Q, Di Z, Qiu W, Yan J. Predictive factors for prolonged operative time of robotic thyroidectomy via bilateral axillo-breast approach: Analysis of 359 cases of differentiated thyroid cancer. Asian J Surg 2021; 45:105-109. [PMID: 33879363 DOI: 10.1016/j.asjsur.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/26/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study assessed the results of robotic thyroidectomy for differentiated thyroid cancer in early stage, to identify the predictive factors of operative time and complication rate. METHODS A patient cohort of 359 cases in total was involved in this retrospective study. The data of clinical characteristics and follow-up results were collected. RESULTS The cohort of patients involved was composed of 285 female patients and 74 male ones. The mean age was 34.91 ± 7.93 years old. The mean Body Mass Index (BMI) was 22.43 ± 3.47. The mean tumor size was 0.75 ± 0.56 cm, and the mean gland size was 4.68 ± 0.83 cm. Among all the specimen, the ratio of tumor invasion of gland capsule was 63/296, and the ratio of chronic thyroiditis was 110/249. 75 patients underwent total thyroidectomy + central compartment node dissection (CCND). 284 patients underwent Lobectomy + CCND. The ratio of central lymph node metastasis was 144/215 (40.1%). The mean number of lymph node dissected was 5.26 ± 4.09. The mean operative time was 96.53 ± 25.69 min. 21(5.8%) patients had hoarseness after operation. 22(29.3%) patients had hypocalcemia after total thyroidectomy. The inadvertent parathyroidectomy was found in 66(18.4%) cases. The surgical extent (unilateral/bilateral resection), BMI and gland size were found to have a significantly correlation with the operative time (p < 0.05) after multivariate analysis. CONCLUSION The surgical extent, BMI and gland size are found to be independent risk factors of prolonged operative time of robotic thyroidectomy. However, these factors are not associated with a higher complication rate.
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Affiliation(s)
- Hanxing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhuoran Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Haoji Gao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Jie Kuang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xi Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Qinyu Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhongmin Di
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China.
| | - Jiqi Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China.
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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]
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Colombo C, Giancola N, Fugazzola L. Personalized treatment for differentiated thyroid cancer: current data and new perspectives. Minerva Endocrinol (Torino) 2020; 46:62-89. [PMID: 33213119 DOI: 10.23736/s2724-6507.20.03342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More conservative and personalized treatment options have been developed in recent years to face the rising diagnosis of low-risk differentiated thyroid carcinoma (DTC). The present review describes the change towards a more risk-adapted management either in the treatment or in the follow-up of DTC. Particular attention is given to the innovations introduced by the latest guidelines for low-risk tumors, starting from the most appropriate extension of surgery up to the postoperative management. The emerging role of active surveillance for low-risk microcarcinoma is discussed, as well as the development of percutaneous strategies in the setting of malignant thyroid disease. The recent use of approved new systemic target therapies for advanced radioiodine refractory thyroid cancer is reported, together with the description of new compounds in trial. Finally, we provide some considerations to improve the risk evaluation in a presurgical setting, especially related to the rising role of genetics, to enable better risk-based cancer management and personalized treatment choices.
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Affiliation(s)
- Carla Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy -
| | - Noemi Giancola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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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]
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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.
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He Q, Zhu J, Zhuang D, Fan Z, Zheng L, Zhou P, Yu F, Wang G, Ni G, Dong X, Wang M, Li X, Liu C, Wang D, Yue T, Hou L, Wang M, Li D. Robotic lateral cervical lymph node dissection via bilateral axillo-breast approach for papillary thyroid carcinoma: a single-center experience of 260 cases. J Robot Surg 2020; 14:317-323. [PMID: 31218501 PMCID: PMC7125246 DOI: 10.1007/s11701-019-00986-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
Abstract
To evaluate the feasibility and safety of robotic lateral cervical lymph node dissection via BABA, 260 thyroid cancer patients with suspected level II, III, IV, and Vb lymph node metastasis were selected. The lateral cervical compartment was exposed by splitting the sternocleidomastoid muscle longitudinally, and separating between the strap muscles and the anterior margin of the sternocleidomastoid muscle. The procedure was completed in 260 patients. Mean time for robotic lateral node dissection took 80 ± 21 min. The wound catheter was removed 6.3 days. Postoperative transient symptomatic hypocalcemia was observed in 51 patients, transient hoarseness in three, seroma in three, chyle leakage in two, and tracheal injury in one. 124 patients were confirmed to have lymph node metastasis on final pathological report. Average postoperative hospital stay was 6.5 days. Robotic lateral neck dissection by BABA is the acceptable operative alternative for thyroid cancer patients who wished to keep their surgical history private.
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Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China.
| | - Jian Zhu
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Dayong Zhuang
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Ziyi Fan
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Luming Zheng
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Fang Yu
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Gang Wang
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Gaofeng Ni
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Xuefeng Dong
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Meng Wang
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Xiaolei Li
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Changrui Liu
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Dan Wang
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Lei Hou
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Mengdi Wang
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
| | - Dandan Li
- Department of Thyroid and Breast Surgery, 960th Hospital of the People's Liberation Army, No. 25 Shifan Road, Jinan, 250031, People's Republic of China
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Remote Access Surgery for Thyroid Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Banerjee H, Ponraj G, Kirthika SK, Suman MV, Lim CM, Ren H. Hydrogel-Shielded Soft Tactile Sensor for Biocompatible Drug Delivery Monitoring. J Med Device 2019. [DOI: 10.1115/1.4044114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractTactile sensing is an emerging technological advancement in surgical robotics in order to probe interactions between confined tissue environments and instruments based on touch information. The tactile sense can assist in improving the efficiency of the whole practice and hence enhance precision, control, and safety during surgery. This paper demonstrates a distinct proof-of-concept therapeutic device equipped with a soft tactile sensor. The tactile sensor was custom-made using flexible piezoresistive materials and conductive ink, wrapped with a biocompatible hydrogel polymer matrix for safer human–tissue interactions. The proposed tactile sensor was then calibrated and its performance was compared with gold standard sensors. It was further tested with a continuous force (5 N) for an extended period of time (about 6 h) to address robustness and repeatability. The sensor showed a sensitivity of 0.833 N−1 and a drift of ≤1%. Successful cadaver experiment demonstrates the efficiency of tactile sensing assistance to clinicians.
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Affiliation(s)
- Hritwick Banerjee
- Department of Biomedical Engineering, Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore 117583
| | - Godwin Ponraj
- Department of Biomedical Engineering, Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore 117583
| | - Senthil Kumar Kirthika
- Department of Biomedical Engineering, National University of Singapore, Singapore 117583
| | - Malapaka Venkata Suman
- Department of Biomedical Engineering, National University of Singapore, Singapore 117583
| | - Chwee Ming Lim
- Department of Otolaryngology, Head and Neck Surgery, National University Health System, Singapore 119228
| | - Hongliang Ren
- Department of Biomedical Engineering, Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore 117583; NUS (Suzhou) Research Institute (NUSRI), Wuzhong District, Suzhou City, Jiangsu 215000, China
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Russell JO, Razavi CR, Shaear M, Chen LW, Lee AH, Ranganath R, Tufano RP. Transoral Vestibular Thyroidectomy: Current State of Affairs and Considerations for the Future. J Clin Endocrinol Metab 2019; 104:3779-3784. [PMID: 30860578 PMCID: PMC6656420 DOI: 10.1210/jc.2019-00116] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a recently described procedure for surgical management of select thyroid pathology that avoids a cutaneous scar. TOETVA is far from the first described remote-access approach to the thyroid. In fact, numerous such techniques have been described over the past 20 years, although none has gained widespread implementation in North America or Europe. However, with its rapid growth worldwide and excellent outcomes to date, TOETVA may succeed where these prior techniques have failed. EVIDENCE ACQUISITION The English literature was reviewed using the following keywords: transoral thyroidectomy, remote-access thyroidectomy, minimally invasive thyroidectomy, and TOETVA. Because three systematic reviews of this technique were recently conducted, this manuscript does not seek to provide a fourth. Rather, we summarize salient findings from these reviews and focus on candidates for the procedure, technique-specific characteristics that have led to early success with TOETVA, and prospects for the future. EVIDENCE SYNTHESIS TOETVA is the only thyroidectomy approach obviating the need for a cutaneous incision, and it offers several advantages over previously described remote-access thyroidectomy techniques. These include a favorable anatomic surgical perspective, a comparatively short learning curve, no requirement for expensive instrumentation, and a broad inclusion criterion. These characteristics have facilitated the excellent surgical outcomes to date. CONCLUSIONS TOETVA is a suitable surgical option with proven safety and feasibility for a carefully selected patient population. The potential value of the procedure outside enhanced cosmesis continues to be defined.
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Affiliation(s)
- 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
| | - 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
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - 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
| | - Andrew H Lee
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - 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
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Razavi CR, Tufano RP, Russell JO. Starting a Transoral Thyroid and Parathyroid Surgery Program. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019; 7:204-208. [PMID: 31396436 DOI: 10.1007/s40136-019-00246-w] [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] [Indexed: 01/03/2023]
Abstract
Purpose of Review To describe the necessary steps to facilitate safe implementation of a transoral thyroid and parathyroid surgery program. Recent Findings Transoral vestibular approaches to the central neck have been demonstrated to be safe and feasible, while avoiding the morbidity of a cutaneous scar. As operative volume expands from a select few high-volume centers, a framework for implementation has been recommended to allow the evidence-based outcomes to translate into clinical practice for new adopters of these techniques. These include securing institutional support, choosing the appropriate candidate (both patient and surgeon), appropriate case observation and instruction (live and cadaver), and adequate first-case preparation and knowledge of the learning curve(s) for the techniques. Summary The recommendations in this article provide a foundation from which a transoral thyroid and parathyroid program may be successfully built. An intricate understanding of conventional transcervical central neck surgery and institutional support are absolute prerequisites to safe and successful implementation of these transoral vestibular techniques.
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Affiliation(s)
- Christopher R Razavi
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
| | - Ralph P Tufano
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
| | - Jonathon O Russell
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
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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.
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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
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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.
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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
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16
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Abstract
Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Julie Ann Sosa
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
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17
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Lira RB, Chulam TC, Kowalski LP. Variations and results of retroauricular robotic thyroid surgery associated or not with neck dissection. Gland Surg 2018; 7:S42-S52. [PMID: 30175063 DOI: 10.21037/gs.2018.03.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Technological advances in the last decades allowed significant evolution in head and neck surgery toward less invasive procedures, with better esthetic and functional outcomes, without compromising oncologic soundness. Although robotic thyroid surgery has been performed for some years now and several published series reported its safety and feasibility, it remains the center of significant controversy. This study shows the results of a case series of robotic thyroid surgery, combined or not with robotic neck dissection. Methods A retrospective cohort including 48 cases of robotic thyroid surgery with or without neck dissection, using retroauricular or combined approaches, performed in a tertiary cancer center, comprised the study. Results Between 2015 and 2017, we performed 2,769 thyroid surgical procedures, of which 48 (1.7%) were robot-assisted, in 46 patients [26 hemithyroidectomies, 7 total thyroidectomies, and 12 total thyroidectomies (or totalization) with selective neck dissection (SND) II-VI; and 3 neck dissections for thyroid carcinoma]. There were 43 (89.6%) women, and the median age was 35 years. The mean hospital stay was 1.9 days. In 3 (6.2%) cases, drains were not placed (hemithyroidectomies), whereas the other 45 (93.8%) cases had a mean drain stay of 4.4 days (range, 1-9 days). The console time (robotic thyroid resection and neck dissection) ranged from 11 to 200 min (mean 66.1 min; median 40 min), and the total operating room time ranged from 80 to 440 min (mean 227.9 min; median 170 min). Three (6.2%) patients had transient vocal cord paresis. Transient hypocalcemia was reported in three cases (6.2%). There were 30 carcinomas (62.5%), and the mean number of retrieved lymph nodes (LNs) (considering only cases that included robotic neck dissection) was 27.2 (range, 17-40). The mean follow-up time was 17.4 months (range, 1.4-31.9 months), and no recurrence was diagnosed. Conclusions The quality outcomes and complication rates are comparable to the conventional approaches. Therefore, robotic thyroidectomy can be an option for selected patients that are motivated to avoid a visible neck scar, treated in high-volume centers. For the patients who require lateral neck dissection, the retroauricular robotic approach could be even more attractive, especially for young patients.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Thiago Celestino Chulam
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
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18
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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19
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Feng AL, Razavi CR, Lakshminarayanan P, Ashai Z, Olds K, Balicki M, Gooi Z, Day AT, Taylor RH, Richmon JD. The robotic ENT microsurgery system: A novel robotic platform for microvascular surgery. Laryngoscope 2017; 127:2495-2500. [PMID: 28581249 DOI: 10.1002/lary.26667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Assess the feasibility of a novel robotic platform for use in microvascular surgery. STUDY DESIGN Prospective feasibility study. SETTING Robotics laboratory. METHODS The Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS) (Galen Robotics, Inc., Sunnyvale, CA) is a robotic arm that stabilizes a surgeon's instrument, allowing precise, tremor-free movement. Six microvascular naïve medical students and one microvascular expert performed microvascular anastomosis of a chicken ischiatic artery, with and without the REMS. Trials were blindly graded by seven microvascular surgeons using a microvascular tremor scale (MTS) based on instrument tip movement as a function of vessel width. Time to completion (TTC) was measured, and an exit survey assessed participants' experience. The interrater reliability of the MTS was calculated. RESULTS For microvascular-naïve participants, the mean MTS score for REMS-assisted trials was 0.72 (95% confidence interval [CI] 0.64-1.07) and 2.40 (95% CI 2.12-2.69) for freehand (P < 0.001). The mean TTC was 1,265 seconds for REMS-assisted trials and 1,320 seconds for freehand (P > 0.05). For the microvascular expert, the mean REMS-assisted MTS score was 0.71 (95% CI 0.15-1.27) and 0.86 (95% CI 0.35-1.37) for freehand (P > 0.05). TTC was 353 seconds for the REMS-assisted trial and 299 seconds for freehand. All participants thought the REMS was more accurate and improved instrument handling and stability. The intraclass correlation coefficient for MTS ratings was 0.914 (95% CI 0.823-0.968) for consistency and 0.901 (95% CI 0.795-0.963) for absolute value. CONCLUSION The REMS is a feasible adjunct for microvascular surgery and a potential teaching tool capable of reducing tremor in novice users. Furthermore, the MTS is a feasible grading system for assessing microvascular tremor. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2495-2500, 2017.
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Affiliation(s)
- Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Christopher R Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
| | | | | | | | | | - Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Russell H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
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20
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Abstract
In thyroid surgery multiple different cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed in the last 20 years. The aim of all these alternative approaches to the thyroid gland is optimization of the cosmetic result. The indications for the use of alternative and conventional approaches are principally the same. Important requirements for the use of alternative methods are nevertheless a broad experience in conventional thyroid operations of the thyroid and adequate patient selection under consideration of the size of the thyroid and the underlying pathology. Contraindications for the use of alternative approaches are a large size of the thyroid gland including local symptoms, advanced carcinomas, reoperations and previous radiations of the anterior neck. The current article gives an overview of the clinically implemented alternative approaches for thyroid surgery. Of those the majority must still be considered as experimental. The alternative approaches to the thyroid gland can be divided in cervical minimally invasive, extracervical endosopic (robot-assisted) and transoral operations (natural orifice transluminal endoscopic surgery, NOTES). Since conventional thyroid operations are standardized procedures with low complication rates, alternative approaches to the thyroid gland are considered critically in Germany. The request for a perfect cosmetic result should not overweigh patients' safety. Only a few alternative approaches (e. g. MIVAT, RAT) can yet be considered as a safe addition in experienced hands in highly selected patients.
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Affiliation(s)
- E Maurer
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland.
| | - S Wächter
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
| | - D K Bartsch
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
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