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Lechien JR, Hamdan AL, Fakhry N, Vaira LA, Iannella G, Gengler IM, Michel J, Radulesco T, Remacle M, Hans S, Cammaroto G, Saibene AM, Mayo-Yanez M, Maniaci A. Perception of Young European Otolaryngologists toward Transoral Robotic Surgery in Head and Neck Oncology and Surgery. J Clin Med 2024; 13:3055. [PMID: 38892767 PMCID: PMC11172773 DOI: 10.3390/jcm13113055] [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: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Background: To investigate the perception of young European otolaryngologists (OTOs), i.e., head and neck surgeons, toward transoral robotic surgery (TORS). Methods: Members of the Young Confederation of European Otorhinolaryngology-Head and Neck Surgery and Young Otolaryngologists of International Federation of Otorhinolaryngological Societies were surveyed about TORS perception and practice. Results: The survey was completed by 120 young OTOS (26%). The most important barriers to TORS were robot availability (73%), cost (69%), and lack of training (37%). The participants believed that the main benefits include better surgical filed view (64%), shorter hospital stay (62%), and better postoperative outcomes (61%) than the conventional approach. Head and neck surgeons considered cT1-T2 oropharyngeal cancers (94%), resection of base of tongue for sleep apnea (86%), or primary unknown cancer (76%) as the most appropriate indications. A total of 67% of TORS surgeons assessed themselves as adequately trained in TORS. Conclusions: Young European OTOs report positive perception, adoption, and knowledge of TORS. The cost-related unavailability and the lack of training or access are reported to be the most important barriers for the spread of TORS.
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Affiliation(s)
- Jerome R. Lechien
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 Paris, France;
- Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Elsan Polyclinic of Poitiers, 86000 Poitiers, France
- Laboratory of Anatomy and Cell Biology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 6, 7000 Mons, Belgium
| | - Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut 1107, Lebanon;
| | - Nicolas Fakhry
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Aix-Marseille Univ, AP-HM, La Conception Hospital, 13005 Marseille, France
| | - Luigi A. Vaira
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giannicola Iannella
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of “Organi di Senso”, University “Sapienza”, 00161 Rome, Italy
| | - Isabelle M. Gengler
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Justin Michel
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Aix Marseille University, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, 13005 Marseille, France
| | - Thomas Radulesco
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Aix Marseille University, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, 13005 Marseille, France
| | - Marc Remacle
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 Paris, France;
- Department of Otolaryngology, Head and Neck Surgery, Eich Hospital, 1460 Eich, Luxembourg
| | - Stephane Hans
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 Paris, France;
| | - Giovanni Cammaroto
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, 47122 Forli, Italy
| | - Alberto M. Saibene
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 26900 Milan, Italy
| | - Miguel Mayo-Yanez
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital San Rafael (HSR), 15006 A Coruña, Spain
| | - Antonino Maniaci
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy
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2
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Zhang X, Yu J, Zhu J, Wei H, Meng N, Hu M, Tang J. A meta-analysis of unilateral axillary approach for robotic surgery compared with open surgery for differentiated thyroid carcinoma. PLoS One 2024; 19:e0298153. [PMID: 38603661 PMCID: PMC11008900 DOI: 10.1371/journal.pone.0298153] [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: 09/12/2023] [Accepted: 01/19/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE The Da Vinci Robot is the most advanced micro-control system in endoscopic surgical instruments and has gained a lot of valuable experience today. However, the technical feasibility and oncological safety of the robot over open surgery are still uncertain. This work is to systematically evaluate the efficacy of the unilateral axillary approach for robotic surgery compared to open surgery for differentiated thyroid carcinoma. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to search for relevant literatures of robotic thyroid surgery using unilateral axillary approach compared to open thyroid surgery, and a meta-analysis was performed using RevMan software version 5.3. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods. RESULTS Twelve studies with a total of 2660 patients were included in the meta-analysis. The results showed that compared with the open group, the robotic group had a longer total thyroidectomy time, shorter hospital stay, less intraoperative bleeding, more postoperative drainage, fewer retrieved central lymph nodes, and higher cosmetic satisfaction (all P < 0.05). In contrast, temporary and permanent laryngeal recurrent nerve injury, temporary and permanent hypoparathyroidism or hypocalcemia, brachial plexus nerve injury, number of retrieved central lymph nodes, number of retrieved lymph nodes in the lateral cervical region, number of lymph node metastases in the lateral cervical region, hematoma, seroma, lymphatic leak, stimulated thyroglobulin (sTg) and unstimulated thyroglobulin (uTg), and the number and recurrence rate of patients with sTg <1ng/ml were not statistically different between the two groups (P > 0.05). CONCLUSIONS The unilateral axillary approach for robotic thyroid surgery may achieve outcomes similar to those of open surgery. Further validation is required in a prospective randomized controlled trial.
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Affiliation(s)
- Xinjun Zhang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Junkang Yu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Jinhui Zhu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Haibo Wei
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ning Meng
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Mingrong Hu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Jingjie Tang
- Institute of Bioengineering and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, Guangdong Province, China
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Nguyen VC, Lee DW, Song CM, Ji YB, Park JS, Tae K. Oncologic outcomes and surgical completeness of remote-access thyroidectomy: a systematic review and network meta-analysis. Langenbecks Arch Surg 2024; 409:117. [PMID: 38598044 DOI: 10.1007/s00423-024-03316-w] [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: 01/26/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The oncologic safety and surgical completeness of remote-access thyroidectomies are not yet clearly established. This study evaluates the oncologic outcomes and surgical completeness of three prevalent remote-access thyroidectomies: the gasless transaxillary approach (GTAA), bilateral axillo-breast approach (BABA), and transoral approach (TOA), in comparison with conventional transcervical thyroidectomy (CTT). METHODS Literature searches were conducted in PubMed, EMBASE, and the Cochrane Library databases, covering the period from 2000 to 2023. Network meta-analyses were performed on selected studies, focusing on recurrence and surgical completeness. Surgical completeness was assessed using stimulated serum thyroglobulin levels and the count of retrieved lymph nodes. RESULTS The review included 48 studies, encompassing a total of 16,356 patients. The number of retrieved lymph nodes was comparable among BABA, TOA, and CTT, while GTAA might be less effective. Stimulated serum thyroglobulin levels showed no significant differences across the four groups. However, the proportion of patients with stimulated thyroglobulin levels below 1.0 ng/mL was significantly lower in GTAA compared to the other groups. The overall recurrence rates were 1.31% for CTT, 0.89% for GTAA, 0.62% for BABA, and 0% for TOA, with no significant differences in recurrence rates when adjusted for follow-up duration. CONCLUSIONS This study demonstrated that the oncologic outcomes of GTAA, BABA, and TOA are comparable to those of CTT, based on recurrence rates. In terms of surgical completeness, BABA and TOA showed equivalence to CTT, whereas GTAA might be inferior to the other techniques.
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Affiliation(s)
- Van Cuong Nguyen
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, 42472, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Bonati E, Mullineris B, Del Rio P, Loderer T, De Gennaro F, Esposito G, Menduni N, Pedrazzi G, Piccoli M. Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes. Updates Surg 2024; 76:573-587. [PMID: 38198118 DOI: 10.1007/s13304-023-01732-z] [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: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20 years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.
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Affiliation(s)
- Elena Bonati
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy.
| | - Barbara Mullineris
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Paolo Del Rio
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Tommaso Loderer
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Flavia De Gennaro
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Giuseppe Esposito
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Nunzia Menduni
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Micaela Piccoli
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
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Yu ST, Ge JN, Sun BH, Wei ZG, Zhang ZC, Chen WS, Li TT, Lei ST. A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report. Heliyon 2024; 10:e24802. [PMID: 38318059 PMCID: PMC10839888 DOI: 10.1016/j.heliyon.2024.e24802] [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] [Received: 08/04/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Background Our objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). Method Between April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients' clinicopathologic characteristics, surgical completeness and complications were analyzed. Result Single-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85-160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3-4.5) days. The median hospitalization expense for these patients was 3848 (3781-4145) USD. The median number of lymph node yielded was 10.5 (8-15). The cosmetic outcomes were well-received by all individuals. Conclusion In certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.
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Affiliation(s)
- Shi-Tong Yu
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jun-Na Ge
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bai-Hui Sun
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhi-Gang Wei
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhi-Cheng Zhang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wei-Sheng Chen
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ting-Ting Li
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Shang-Tong Lei
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
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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.
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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
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Maniaci A, Chiesa Estomba C, Fakhry N, Vaira LA, Remacle M, Cammaroto G, Barillari MR, Iannella G, Mayo-Yanez M, Saibene AM, Baudouin R, Maza-Solano J, Mendelsohn AH, Holsinger FC, Ceccon FP, Haddad L, Hans S, La Mantia I, Cocuzza S, Gulinello F, Ayad T, Lechien JR. Influence of Otolaryngological Subspecialties on Perception of Transoral Robotic Surgery: An International YO-IFOS Survey. J Pers Med 2023; 13:1717. [PMID: 38138944 PMCID: PMC10744671 DOI: 10.3390/jpm13121717] [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: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To investigate perception, adoption, and awareness on the part of otolaryngology and head and neck surgeons (OTO-HNS) of transoral robotic surgery (TORS). METHODS Several items assessed: awareness/perception; access to TORS; training; indications and advantages/hurdles to TORS practice. A subanalysis was performed to assess differences according to the identified otolaryngological subspecialties. RESULTS A total of 359 people completed the survey. Among subspecialties, while for otolaryngologists 30/359 (8.4%) and H&N surgeons 100/359 (27.9%) TORS plays an effective role in hospital stay, laryngologists frequently disagreed (54.3%). There was a lower incidence among rhinologists and otologists (1.9%). Pediatric surgeons (0.8%) reported a positive response regarding the adoption of robotic surgery, and head and neck specialists expressed an even greater response (14.2%). Low adherence was related to perceived cost-prohibitive TORS, by 50% of H&N surgeons. CONCLUSIONS Perception, adoption, and knowledge about TORS play a key role in the application of the robotic system, significantly varying across subspecialties.
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Affiliation(s)
- Antonino Maniaci
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Carlos Chiesa Estomba
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, 20003 San Sebastian, Spain
| | - Nicolas Fakhry
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Luigi Angelo Vaira
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07025 Sassari, Italy
| | - Marc Remacle
- Department of Otorhinolaryngology-Head and Neck Surgery, CHL-Eich, Rue d’Eich 78, 1111 Luxembourg, Luxembourg;
| | - Giovanni Cammaroto
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Maria Rosaria Barillari
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, 80121 Naples, Italy
| | - Giannicola Iannella
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161 Rome, Italy
| | - Miguel Mayo-Yanez
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, 15001 Galicia, Spain
| | - Alberto Maria Saibene
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20121 Milan, Italy
| | - Robin Baudouin
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Juan Maza-Solano
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Service of Otolaryngology, ENT Deparment, Virgen de la Macarena University Hospital,41000 Seville, Spain
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 94305, USA;
| | - Floyd Christopher Holsinger
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Fabio P. Ceccon
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Federica Gulinello
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Tareck Ayad
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Division of Otolaryngology-Head and Neck Surgery, Center Hospitalier de l’Université de Montréal, Head and Neck Deparment, Montreal, QC 54550, Canada
| | - Jerome R. Lechien
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75000 Paris, France
- Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7031 Mons, Belgium
- Department of Otolaryngology and Head and Neck Surgery, Elsan Polyclinic of Poitiers, 86000 Poitiers, France
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8
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Lee SJ, Ryu SR, Ji YB, Song CM, Park JH, Kim DS, Tae K. Five-Year Oncologic Outcome and Surgical Completeness of Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Comparison with Conventional Transcervical Thyroidectomy Using Propensity Score Matching. Ann Surg Oncol 2023; 30:2256-2264. [PMID: 36602660 DOI: 10.1245/s10434-022-13020-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate the oncological outcomes and surgical completeness of transoral robotic thyroidectomy (TORT) for papillary thyroid carcinoma (PTC) compared with conventional transcervical thyroidectomy. METHODS We analyzed 489 patients with PTC who underwent thyroidectomy with or without central neck dissection (CND; 311 conventional thyroidectomy and 178 TORT) between January 2017 and December 2021. Patients with gross invasion of the surrounding structures, revision or completion thyroidectomy, and lateral neck dissection were excluded. Propensity score-matched analysis was performed using eight covariates, including age, sex, extent of thyroidectomy, tumor size, extrathyroidal extension (ETE), radioactive iodine (RAI) ablation, lymphovascular invasion (LVI), and CND. RESULTS Before propensity score matching (PSM), age, male-to-female ratio, and body mass index were lower in the TORT group. The ratio of total thyroidectomy and CND, tumor size and bilaterality, LVI, and RAI ablation were higher in the conventional group. PSM generated two matched groups of 100 patients each. After PSM, significant differences between the two groups in the baseline analysis disappeared. In the matched samples, the recurrence rate (2% and 0% in the conventional and TORT groups, respectively) and recurrence-free survival curves did not differ between the two groups. The mean thyroid-stimulating hormone (TSH)-stimulated thyroglobulin level in the RAI group and TSH-suppressed thyroglobulin level in the non-RAI group were not different between the two groups. CONCLUSIONS The 5-year oncologic outcomes and surgical completeness of TORT were comparable with those of conventional thyroidectomy in patients with small, localized, low-risk PTC when performed by experienced surgeons.
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Affiliation(s)
- Song Jae Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Soo Rack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jung Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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9
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Safety and Feasibility of Single-Port Trans-Axillary Robotic Thyroidectomy: Experience through Consecutive 100 Cases. Medicina (B Aires) 2022; 58:medicina58101486. [PMID: 36295646 PMCID: PMC9611002 DOI: 10.3390/medicina58101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives: Recently, the single-port (SP) robotic system was introduced for minimally invasive operative techniques. Thus, this study aimed to validate the safety and feasibility of SP trans-axillary robotic thyroidectomy (SP-TART) through experiences in a single tertiary institution. Materials and Methods: This study retrospectively analyzed 100 consecutive patients who underwent SP-TART from October 2021 to June 2022 in Seoul St. Mary’s Hospital in Seoul, Korea. We analyzed the clinicopathological characteristics and perioperative outcomes, including complications. Results: Less than total thyroidectomy (LTT) was performed in 81, total thyroidectomy (TT) in 16, and TT with modified radical neck dissection (mRND) in 3 patients. The mean operation time (min) was 53.3 ± 13.7, 86.3 ± 15.1, and 245.7 ± 36.7 in LTT, TT, and TT with mRND, respectively. The mean postoperative hospital stay was 2.0 ± 0.2, 2.1 ± 0.3, and 3.7 ± 1.5 days, respectively. A total of 84 cases of thyroid cancer were included, and 97.6% of them (82 cases) were papillary carcinoma and the rest were follicular and poorly differentiated carcinomas. Regarding complications, five cases had major complications, including three cases of vocal cord palsy and two cases of transient hypoparathyroidism. Conclusions: SP-TART is safe and feasible with a short operation time and a short length of hospital stay.
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10
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Paek SH, Kwon H, Kang KH. A Comparison of the Bilateral Axillo-breast Approach (BABA) Robotic and Open Thyroidectomy for Papillary Thyroid Cancer After Propensity Score Matching. Surg Laparosc Endosc Percutan Tech 2022; 32:537-541. [PMID: 36044331 DOI: 10.1097/sle.0000000000001085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND We aimed to investigate the potential advantages of bilateral axillo-breast approach (BABA) robotic thyroidectomy over conventional open surgery and to determine whether it is a safe and complete surgical procedure compared with open surgery in patients with papillary thyroid cancer. PATIENTS AND METHODS We retrospectively reviewed the records of 315 consecutive patients (robotic, n=54; open, n=261) who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer from March 2013 to June 2014. Postoperative complication rate and surgical completeness were analyzed between patients who underwent BABA robotic thyroidectomy (robotic group) and those who chose open thyroidectomy (open group) after propensity score matching according to age, sex, body mass index, tumor size, extrathyroidal extension, and lymph node (LN) metastasis. RESULTS Transient hypoparathyroidism was higher in the open group than in the robotic group (13.0% vs. 1.9%; P =0.029). No difference was observed in the mean number of retrieved LNs and metastatic LNs. The mean level of stimulated thyroglobulin was acceptably low in both groups, and there was no difference in the proportion of patients who had stimulated thyroglobulin levels <1 ng/mL between the groups ( P =0.543). CONCLUSIONS Our results show that the outcomes of BABA robotic thyroidectomy may be comparable to those of conventional open thyroidectomy, with possibly better preservation of blood supply to the parathyroid glands, without sacrificing surgical completeness.
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Affiliation(s)
- Se Hyun Paek
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
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11
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Li C, Gao Y, Zhou P, Yue T, Xu J, Shao C, Liu Y, Zhuang D, He Q, Li X. Comparison of the Robotic Bilateral Axillo-Breast Approach and Conventional Open Thyroidectomy in Pediatric Patients: A Retrospective Cohort Study. Thyroid 2022; 32:1211-1219. [PMID: 35943878 DOI: 10.1089/thy.2022.0242] [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] [Indexed: 11/13/2022]
Abstract
Background: Operations for pediatric thyroid nodules are more complicated, and usually lead to longer scars, which may impair life quality in the long term. Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) may provide a better alternative to conventional open thyroidectomy (COT) for pediatric thyroid nodules. Our study aimed at comparing the surgical and oncological outcomes of BABA RT and COT in pediatric patients. Methods: The data of 49 pediatric patients who consecutively underwent BABA RT or COT (20:29) between July 1998 and November 2021 in our center were retrospectively analyzed, including demographics, surgery extent, surgical outcomes, pathological characteristics, and oncological outcomes. Results: All BABA RT procedures were completed successfully without conversion to open operation. The BABA RT group consisted of 5 benign and 15 malignant cases, while the COT group consisted of 19 benign and 10 malignant cases. The operation time, drain removal time, and number of lymph nodes harvested by central lymph node dissection or lateral lymph node dissection were equivalent in the BABA RT and COT groups. Notably, the postoperative hospital stay of the BABA RT group was shorter than that of the COT group (8.5 [interquartile ranges (IQRs): 3] vs. 11 [IQR: 8] days, p = 0.008). The aesthetic score of the BABA RT group was much higher than that of the COT group (9 [IQR: 1] vs. 6 [IQR: 1], p < 0.001). There was no significant difference between the BABA RT and COT groups in hypoparathyroidism rate (transient, 5 vs. 4; permanent, 1 vs. 0). There was one case of chyle leakage in the COT group and no other complications in any group, such as recurrent laryngeal nerve injury. With a median follow-up of 101 (IQR: 189) months, one case of local relapse and one case of pulmonary metastasis in the COT group were documented. Conclusion: In the hands of experienced surgeons, robotic BABA thyroidectomy can be a safe and effective option for both benign and malignant thyroid nodules in children, including those with lymph node metastasis. Robotic BABA thyroidectomy can offer a better and faster postoperative course and a much better cosmetic result, which is crucial for pediatric thyroid patients.
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Affiliation(s)
- Chenyu Li
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Yuan Gao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
- Department of General Surgery, the 963rd Hospital of People's Liberation Army, Jiamusi, China
- Department of Hepatobiliary Surgery, Xi-Jing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Jing Xu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Changxiu Shao
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yongxiang Liu
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Dayong Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
| | - Xiaolei Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan, China
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12
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Saito Y, Ikeda Y, Takami H, Nakao A, Ho K, Tokuda T, Miyata R, Tomita M, Sato M, Ando N. Combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomy: a novel approach for cervicomediastinal goiters. Langenbecks Arch Surg 2022; 407:2169-2175. [PMID: 35689707 DOI: 10.1007/s00423-022-02579-5] [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: 10/28/2021] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG). PATIENTS AND METHODS The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy. RESULTS We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy. CONCLUSIONS Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients.
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan. .,Department of Surgery, Keio University School of Medicine, Tokyo, Japan. .,Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA. .,Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
| | - Yoshifumi Ikeda
- Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.,Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
| | | | - Atsushi Nakao
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan.,Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiso Ho
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Toshiki Tokuda
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Ryohei Miyata
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Michio Sato
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Nobutoshi Ando
- Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan
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13
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Postsurgical complications after robot-assisted transaxillary thyroidectomy: critical analysis of a large cohort of European patients. Updates Surg 2022; 74:511-517. [PMID: 35239151 PMCID: PMC8995261 DOI: 10.1007/s13304-022-01244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022]
Abstract
In the last decade, robot-assisted trans-axillary thyroidectomy has spread rapidly and has been proven to be a safe and effective procedure. However, several case series have reported new complications that have led to criticism regarding this approach. This study analyzed the incidence of complications in a large cohort of European patients. We enrolled all patients who underwent robot-assisted trans-axillary thyroidectomy from 2012 to 2020 at the University Hospital of Pisa Department of Endocrine Surgery. We analyzed complications and divided them into 2 groups. Group A included conventional complications, such as transient or permanent recurrent laryngeal nerve palsy, transient or permanent hypocalcemia, hemorrhage, and tracheal injury. Group B included unconventional complications, such as brachial plexus palsy, track seeding, seroma, great vessels injury, and skin flap perforation. There were 31 postsurgical complications (5.7%). Group A included 25 complications (4.6%): transient and permanent recurrent laryngeal nerve palsy occurred in 7 patients (1.3%) and in 1 (0.2%), respectively; transient and permanent hypocalcemia occurred in 9 patients (1.7%) and in 1 (0.2%), respectively. Postoperative bleeding occurred in 6 patients (1.1%) and tracheal injury in 1 (0.2%). Group B included 6 complications (1.1%): 1 patient with brachial plexus injury (0.2%), 1 with track seeding (0.2%), and 4 with seroma (0.7%). Robotic trans-axillary thyroidectomy is a safe approach with a risk of postoperative complications comparable to the conventional technique. Almost all complications after a novel introduction are anecdotal. With an accurate patient selection, high-volume institutions with experienced surgeons can perform this technique safely.
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14
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Kudpaje A, Subash A, Subramaniam N, Palme CE, US VR, Arakeri G. Remote Access Thyroid Surgery: A Review of Literature. Indian J Surg Oncol 2022; 13:191-198. [PMID: 35462662 PMCID: PMC8986942 DOI: 10.1007/s13193-021-01364-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.
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Affiliation(s)
- Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health, Bengaluru, Karnataka India
| | - Carsten E. Palme
- Department of Head and Neck Surgery, The Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, Australia
| | - Vishal Rao US
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
- Department of Oral and Maxillofacial Surgery, Novodaya Dental College and Hospital, Raichur, India
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15
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Sanabria A, Pinillos P, Lira RB, Shah JP, Tufano RP, Zafereo ME, Nixon IJ, Randolph GW, Simo R, Vander Poorten V, Rinaldo A, Medina JE, Khafif A, Angelos P, Mäkitie AA, Shaha AR, Rodrigo JP, Hartl DM, Kowalski LP, Ferlito A. Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review. Head Neck 2021; 44:226-237. [PMID: 34590380 DOI: 10.1002/hed.26883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023] Open
Abstract
Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/IPS Universitaria/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello/Clínica Las Vegas-grupo Quirónsalud, Medellín, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia-Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Renan B Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ralph P Tufano
- Director of the FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Gregory W Randolph
- Thyroid/Parathyroid Endocrine Surgical Division, Thyroid Surgical Oncology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ricard Simo
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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16
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Pavlidis ET, Psarras KK, Symeonidis NG, Martzivanou ECK, Nikolaidou CC, Stavrati KE, Pavlidis TE. Robot-Assisted Thyroidectomy Versus Open Thyroidectomy in the Treatment of Well Differentiated Thyroid Carcinoma. JSLS 2021; 25:JSLS.2021.00032. [PMID: 34354333 PMCID: PMC8325479 DOI: 10.4293/jsls.2021.00032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of thyroid cancer has increased worldwide during the last decade, becoming the most common endocrine malignancy and accounting for 3.8% of new cancer diagnosis. Surgical resection, namely conventional thyroidectomy, remains at the frontline of therapy, as surgical outcomes are undoubtedly successful. Minimally invasive techniques gained popularity through the years, in terms of feasibility, safety, and cosmesis. However, endoscopic approach could be characterized by some limitations concerning thyroid surgery. Robotic technology with its unique features was introduced to overcome these limitations. Since then, robotic thyroidectomy has been used for both benign and malignant thyroid disease. DATABASE This study presents the use of robot-assisted transaxillary thyroidectomy in well-differentiated thyroid carcinoma through an extensive review of the literature in the PubMed database, including previous meta-analyses and case series. CONCLUSION In terms of oncological efficacy, morbidity, and quality of life, outcomes seem comparable in thyroid cancer patients undergoing either open or robotic thyroidectomy. Surgical completeness also appears similar. Moreover, the rates of locoregional recurrence and survival outcome at 5 years are similar between the former and the latter, thus confirming the oncological value of robotic thyroidectomy for differentiated thyroid cancer. In order for more surgeons to adopt robotic approaches several issues need to be resolved, namely: expansion of robotic thyroidectomy in treating larger well-differentiated carcinomas and neck dissection, equipment costs, and prolonged operation times.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kyriakos K Psarras
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Eirini-Chrysovalantou K Martzivanou
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Christina C Nikolaidou
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kalliopi E Stavrati
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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17
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Yu DY, Chang YW, Lee HY, Kim WY, Kim HY, Lee JB, Son GS. Detailed comparison of the da Vinci Xi and S surgical systems for transaxillary thyroidectomy. Medicine (Baltimore) 2021; 100:e24370. [PMID: 33546074 PMCID: PMC7837914 DOI: 10.1097/md.0000000000024370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.
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18
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Lee DW, Bang HS, Jeong JH, Kwak SG, Choi YY, Tae K. Cosmetic outcomes after transoral robotic thyroidectomy: Comparison with transaxillary, postauricular, and conventional approaches. Oral Oncol 2021; 114:105139. [PMID: 33460884 DOI: 10.1016/j.oraloncology.2020.105139] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Transoral thyroidectomy does not involve neck incision, and its postoperative cosmetic outcome is thought to be superior to that of conventional thyroidectomy and other remote-access procedures. This study aimed to compare the cosmetic outcomes between transoral robotic thyroidectomy (TORT) and conventional transcervical thyroidectomy and two common remote-access robotic thyroidectomies via the transaxillary and postauricular approaches. MATERIALS AND METHODS We analyzed 160 patients who underwent TORT, robotic thyroidectomies via the transaxillary or postauricular approach, or conventional transcervical thyroidectomy (40 patients in each group). The postoperative cosmetic outcomes, including cosmetic satisfaction and scar consciousness scores, were evaluated using self-assessment cosmesis questionnaires at 3 months and 1 year postoperatively. The cosmesis index was defined as the sum of the percentage scores for cosmetic satisfaction and scar consciousness. RESULTS Cosmetic satisfaction scores, scar consciousness scores, and cosmesis indexes were significantly higher for the transoral, transaxillary, and postauricular approaches than the conventional approach at 3 months and 1 year postoperatively. There was a trend of better cosmetic outcomes, especially regarding scar consciousness, for the transoral and transaxillary approaches than for the postauricular approach, but the difference was not statistically significant. CONCLUSION Postoperative cosmesis of TORT, as well as the transaxillary and postauricular approaches, is superior to that of conventional thyroidectomy. The cosmetic outcomes of the transoral and transaxillary approaches seem to be better than those of the postauricular approach.
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Affiliation(s)
- Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea; Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Hyang Sook Bang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Sang Gyu Kwak
- Department of Medical Statistics, School of Medicine, Catholic University of Daegu, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea.
| | - Yun Young Choi
- Department of Nuclear Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
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19
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Lee DW, Kim JK, Tae K. Application of the transoral endoscopic vestibular approach for a benign upper neck mass: A case report. Medicine (Baltimore) 2021; 100:e24087. [PMID: 33466169 PMCID: PMC7808487 DOI: 10.1097/md.0000000000024087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Excision of a benign neck mass is traditionally performed via the transcervical approach. In order to avoid visible scars in the neck, various remote access surgical approaches have been developed. The aim of this report is to present the technique of a transoral endoscopic vestibular approach for treatment of a benign upper neck mass. PATIENT CONCERNS A 47-year-old female with an anterior upper neck mass and throat discomfort visited our institution. DIAGNOSIS The computed tomography (CT) scans and ultrasound (US) images demonstrated a benign-appearing mass on the anterior upper neck area. INTERVENTIONS The benign upper neck mass was successfully removed via the transoral endoscopic vestibular approach, without any complication. OUTCOMES The final pathologic report indicated that the lesion was an epidermal cyst. The cosmetic result was excellent. LESSONS From this case study, we can learn to apply a transoral endoscopic vestibular approach for removal of a benign upper neck mass. Based on the outcomes, endoscopic removal of the benign upper neck mass via a transoral vestibular approach can be useful for patients who wish to hide any anterior neck scar.
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Affiliation(s)
- Dong Won Lee
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu
| | - Kyung Tae
- Department of Otolaryngology – Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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20
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Saito Y, Ikeda Y, Katoh H, Nakao A, Takami H. Is total endoscopic parathyroidectomy an acceptable treatment for patients with primary hyperparathyroidism due to a presumed solitary adenoma?-comparison of minimally invasive total endoscopic parathyroidectomy and open minimally invasive parathyroidectomy. Gland Surg 2021; 10:83-89. [PMID: 33633965 DOI: 10.21037/gs-20-526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Remote-access thyroidectomy and its cosmetic merit have been widely accepted, but remote-access parathyroidectomy has not become common. There are few reports about the risks and effectiveness of a remote-access endoscopic parathyroidectomy. Herein, we evaluated the risks and benefits of total endoscopic parathyroidectomy (TEP) for patients with primary hyperparathyroidism (PHPT). We retrospectively compared the surgical outcomes of TEP and open minimally invasive parathyroidectomy (MIP). Methods We analyzed the cases of 28 patients with PHPT who were scheduled to undergo a MIP at Mita Hospital (Tokyo) during the period from April 2015 to March 2019, all of whom were presumed preoperatively to have a single adenoma. Results Eleven of the patients underwent a TEP (10 females, one male; mean age 54.2 years). The other 17 patients underwent an open MIP (11 females, 6 males; mean age 63.5 years). The younger patients and the females tended to select endoscopic surgery as their treatment. The operation time was significantly longer in the TEP group compared to the open MIP group (106 vs. 50 min; P<0.001). Common postoperative complications (such as recurrent laryngeal nerve paralysis and seroma) did not occur in this series. For the TEP patients who did not undergo a partial thyroidectomy, the mean amount of drainage on the first postoperative day was only 19±10 mL. The operative cure rate of the minimally invasive parathyroidectomies was 96.4%. Conclusions TEP is a good surgical procedure for hyperparathyroidism caused by a single adenoma, and it achieves superior cosmetic results without increasing the rate of complications.
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, International Goodwill Hospital, Yokohama, Kanagawa, Japan.,Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan
| | - Yoshifumi Ikeda
- Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
| | - Hiroshi Katoh
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Atsushi Nakao
- Department of Surgery, International Goodwill Hospital, Yokohama, Kanagawa, Japan.,Department of Surgery Gastroenterology Center, International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, Shibuya-ku, Tokyo, Japan
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21
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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.
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22
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Abstract
Various remote access robotic thyroidectomy techniques have been developed using the da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA) to hide or avoid neck scarring and overcome the limitations of endoscopic thyroidectomy. Among those used today are the gasless transaxillary approach, the bilateral axillo-breast approach (BABA), the gasless postauricular facelift approach, and the transoral approach. Especially, the recently introduced transoral approach (including robotic and endoscopic procedures) is prominent and now popular worldwide. The most significant advantages of remote access robotic thyroidectomy are excellent postoperative cosmesis and voice outcomes. The important limitations to the adoption of robotic thyroidectomy are the difficult technique, high complication rate during the learning curve, and high cost. In addition, cultural differences, longer operative times, and medicolegal issues are a barrier to the diffusion of robotic thyroidectomy. However, remote access robotic thyroidectomy is feasible, and the outcomes are comparable to those of conventional transcervical thyroidectomy if performed by experienced surgeons in highly selected patients. This article reviews the evolution and recent advances in robotic thyroid surgery.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
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23
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Tai DKC, Kim HY, Park D, Russell JO, Tufano RP, Kandil E. Does Tumor Size Affect Surgical Outcomes of Transoral Robotic Thyroidectomy for Patients with Papillary Thyroid Carcinoma? A Retrospective Cohort Study. Ann Surg Oncol 2020; 27:3842-3848. [DOI: 10.1245/s10434-020-08429-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 12/22/2022]
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24
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Ji YB, Ko SH, Song CM, Sung ES, Lee BJ, Wu CW, Chiang FY, Tae K. Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy. Oral Oncol 2020; 103:104617. [DOI: 10.1016/j.oraloncology.2020.104617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/24/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
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25
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Lee DW, Ko SH, Song CM, Ji YB, Kim JK, Tae K. Comparison of postoperative cosmesis in transaxillary, postauricular facelift, and conventional transcervical thyroidectomy. Surg Endosc 2019; 34:3388-3397. [PMID: 31515625 DOI: 10.1007/s00464-019-07113-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 08/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The most important advantage of remote-access robotic and endoscopic thyroidectomies is believed to be the excellent postoperative cosmesis. The purpose of this study was to compare directly the postoperative cosmetic outcomes of robotic/endoscopic thyroidectomy via gasless transaxillary and postauricular facelift approaches with those of conventional thyroidectomy. METHODS We prospectively studied 100 patients who underwent robotic/endoscopic thyroidectomy using a gasless unilateral axillary (GUA) approach (50 patients) or a postauricular facelift approach (50 patients), and 50 who underwent conventional transcervical thyroidectomy. Postoperative cosmetic satisfaction scores and scar consciousness scores were evaluated at 3 months and 1 year after surgery using questionnaires developed by us. Vancouver scar scales were evaluated at the same time. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1-5 each. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0-3 each. RESULTS The cosmetic satisfaction and scar consciousness scores were significantly lower (corresponding to greater satisfaction) in the transaxillary and postauricular facelift groups than the conventional group at 3 months and 1 year postoperatively. They did not differ between the transaxillary and postauricular facelift groups. However, the Vancouver scar scale score of the conventional group was significantly lower than those of the transaxillary and postauricular facelift groups (P < 0.001 in both). CONCLUSION Robotic/endoscopic thyroidectomy via transaxillary or postauricular facelift approaches results in better cosmesis than the conventional approach. However, scar healing itself is worse in the transaxillary and facelift approaches than the conventional approach.
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Affiliation(s)
- Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Seok Hwa Ko
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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26
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Extracervical Approaches to Thyroid Surgery: Evolution and Review. Minim Invasive Surg 2019; 2019:5961690. [PMID: 31531238 PMCID: PMC6719267 DOI: 10.1155/2019/5961690] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/10/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.
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27
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Vidal O, Saavedra-Perez D, Vilaça J, Pantoja JP, Delgado-Oliver E, Lopez-Boado MA, Fondevila C. Cirugía endocrina cervical mínimamente invasiva. Cir Esp 2019; 97:305-313. [DOI: 10.1016/j.ciresp.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/29/2023]
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28
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Yu HW, Bae IE, Yi JW, Lee JH, Kim SJ, Chai YJ, Choi JY, Lee KE. The application of subcapsular saline injection during bilateral axillo-breast approach robotic thyroidectomy: a preliminary report. Surg Today 2019; 49:420-426. [PMID: 30604214 DOI: 10.1007/s00595-018-1748-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Saving the parathyroid gland during robotic thyroidectomy is challenging. This study evaluated the application of a novel method, subcapsular saline injection (SCASI), to save the parathyroid gland during bilateral axillo-breast approach (BABA) robotic total thyroidectomy. METHODS Of the 81 included patients operated on from 2014 to 2016, 31 and 50 underwent BABA robotic total thyroidectomy with and without SCASI, respectively. Serum concentrations of parathyroid hormone (PTH), calcium, and ionized calcium were measured at 1 day and 9 months postoperatively. Transient hypoparathyroidism was defined as PTH < 10.0 pg/mL after 1 day and permanent hypoparathyroidism as PTH < 15.0 pg/mL at 9 months. RESULTS There were no significant clinicopathologic differences between the two groups. The rate of transient hypoparathyroidism was significantly lower in the SCASI group than in the non-SCASI group [16.1% (5/31) vs. 44% (22/50), p < 0.01]. However, the rates of permanent hypoparathyroidism [0% (0/31) vs. 4% (2/50), p = 0.699] did not differ significantly. CONCLUSIONS SCASI is a feasible and safe method of saving the parathyroid gland during BABA robotic total thyroidectomy.
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Affiliation(s)
- Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - In Eui Bae
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Jin Wook Yi
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Joon-Hyop Lee
- Department of Surgery, Gachon University College of Medicine, Gil Medical Center, 774, Namdong-daero, Namdong-gu, Incheon, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, South Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
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29
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Tae K, Lee DW, Song CM, Ji YB, Park JH, Kim DS, Tufano RP. Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures. Head Neck 2018; 41:730-738. [DOI: 10.1002/hed.25426] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine, Hanyang University; Seoul South Korea
| | - Jung Hwan Park
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Dong Sun Kim
- Department of Internal Medicine; College of Medicine, Hanyang University; Seoul South Korea
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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30
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Comparison of short-term oncologic outcome of robotic thyroid surgery using dynamic risk stratification: A propensity score-matched comparison study. Surgery 2018; 165:608-616. [PMID: 30219245 DOI: 10.1016/j.surg.2018.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/31/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The long-term oncologic outcome of robotic surgery for thyroid cancer is not well established. The aim of this study was to predict the long-term oncologic outcome of robotic surgery by using dynamic risk stratification in classic papillary thyroid carcinoma. METHODS A total of 444 propensity score-matched pairs of patients with papillary thyroid carcinoma treated with robotic surgery and conventional open surgery were classified into 4 response-to-therapy categories. The results were compared between the robotic surgery and open surgery groups. RESULTS The median follow-up duration was 60 months. After propensity score matching, the robotic surgery group showed less extensive thyroid surgery and lymph node dissection and a higher proportion of patients who underwent radioactive iodine remnant ablation than the open surgery group; however, the dynamic risk stratification did not differ between the 2 groups (P = .086). CONCLUSION The long-term oncologic outcome of robotic surgery is expected to be comparable with that of open surgery based on the dynamic risk stratification.
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Tae K, Ji YB, Song CM, Ryu J. Robotic and Endoscopic Thyroid Surgery: Evolution and Advances. Clin Exp Otorhinolaryngol 2018; 12:1-11. [PMID: 30196688 PMCID: PMC6315214 DOI: 10.21053/ceo.2018.00766] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
To minimize surgical morbidity and neck scarring, minimally invasive thyroidectomy and robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular or transoral approaches have been developed over the past 20 years. In this article, we review the evolution of robotic and endoscopic thyroid surgery and recent advances. Among remote access approaches, the gasless transaxillary approach, bilateral axillo-breast approach, postauricular facelift approach, and transoral vestibular approach are in common use today. Each procedure has its own advantages and disadvantages. Therefore, we need to understand these advantages and limitations, and to select the appropriate method for each patient. The most significant advantage of remote access thyroidectomy is its excellent cosmesis. The complication rate is similar in patients undergoing a remote access approach and those undergoing conventional surgery if the former is performed by experienced surgeons. Operative time is significantly longer in remote access thyroidectomy. In conclusion, remote access thyroidectomy is feasible and its outcomes are comparable to those of conventional transcervical thyroidectomy in highly selected patients.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
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Kim MJ, Nam KH, Lee SG, Choi JB, Kim TH, Lee CR, Lee J, Kang SW, Jeong JJ, Chung WY. Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies. World J Surg 2018; 42:393-401. [PMID: 28879559 DOI: 10.1007/s00268-017-4209-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Since the use of robot systems in thyroid surgery was introduced in 2007, we have advanced a novel method of robotic thyroidectomy (RT) using a gasless transaxillary approach (TAA). We report our experience with this technique and detail the surgical outcome of 5000 robotic thyroidectomies. METHODS From October 2007 to May 2016, we successfully performed 5000 robotic thyroidectomies using a gasless TAA at the Department of Surgery, Yonsei University Health System. The medical records of the patients are reviewed retrospectively, and the details of clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes are analyzed. RESULTS The 5000 patients with thyroid tumor (4804 with cancer and 196 with benign tumor) underwent RT using a gasless TAA. Mean operation time was 134.5 ± 122.0 min. The most common histologic subtype of thyroid cancer was papillary (98%), and the mean tumor size was 8.0 ± 6.0 mm. Stage I was found in 85.4% patients regarding tumor nodes metastasis staging. The 196 benign tumors consisted of 104 adenomatous hyperplasias (53.0%), 43 follicular adenomas (21.9%), 30 Graves' diseases (15.3%), and 19 others (9.7%). Postoperative complication occurred in 24.1% without any serious one, and overall morbidity tended to decrease over time. No disease-specific mortality was observed during the follow-up period. Locoregional recurrence was developed in 26 patients (0.5%). CONCLUSION The authors have tried to improve RT technique using gasless TAA and achieved acceptable surgical outcomes. The rapid evolution of surgical robot technology and our constant effort to advance RT technique using gasless TAA would make it possible to reduce the perioperative morbidity and gain the best possible operative and oncologic outcomes.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Seul Gi Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jung Bum Choi
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Tae Hyung Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Cho Rok Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jandee Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sang-Wook Kang
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Woong Youn Chung
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Krishnan G, Mintz J, Foreman A, Hodge JC, Krishnan S. The acceptance and adoption of transoral robotic surgery in Australia and New Zealand. J Robot Surg 2018; 13:301-307. [DOI: 10.1007/s11701-018-0856-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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Initiating a Robotic Thyroidectomy Program in India. Indian J Surg Oncol 2018; 9:241-246. [PMID: 29887708 DOI: 10.1007/s13193-018-0746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022] Open
Abstract
Robotic surgery has been successfully used for many surgical indications in head and neck surgery. Robotic thyroidectomy is getting accepted worldwide, but the majority of the literature is from South Korea. The purpose of the paper is to review and give a personal perspective on how a robotic thyroidectomy program was initiated in a tertiary care academic medical institution in India. Advantages of robotic approaches are the three-dimensional visualization, precision, dexterity, and surgeon ergonomics. Cost is an important concern. Training includes basic robotics skill training, cadaveric training, observership, and hands-on training. Sufficient preclinical and clinical training is essential before embarking onto the newer surgical modality. Surgeon credentialing, though institution dependent, has specific guidelines. Case selection is the key, especially in the initial learning curve. The authors prefer the retroauricular approach for robotic thyroidectomy, and our initial experience in the first ten cases of total thyroidectomy was encouraging.
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Aidan P, Arora A, Lorincz B, Tolley N, Garas G. Robotic Thyroid Surgery: Current Perspectives and Future Considerations. ORL J Otorhinolaryngol Relat Spec 2018; 80:186-194. [PMID: 29788019 DOI: 10.1159/000488354] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/12/2018] [Indexed: 01/16/2023]
Abstract
Robotic transaxillary thyroidectomy, pioneered in South Korea, is firmly established throughout the Far East but remains controversial in Western practice. This relates to important population differences (anthropometry and culture) compounded by the smaller mean size of thyroid nodules operated on in South Korea due to a national thyroid cancer screening programme. There is now level 2 evidence (including from Western World centres) to support the safety, feasibility, and equivalence of the robotic approach to its open counterpart in terms of recurrent laryngeal nerve injury, hypoparathyroidism, haemorrhage, and oncological outcomes for differentiated thyroid cancer. Moreover, robotic thyroidectomy has been shown to be superior to open surgery for certain patient-reported outcome measures, namely scar cosmesis and pain. Downsides include its high cost, longer operative time, and risk of complications not encountered in open thyroidectomy (brachial plexus neurapraxia). Careful patient selection is paramount as this procedure is not for every patient, surgeon, or hospital. It should only be undertaken by high-volume surgeons operating as part of a multidisciplinary robotic team in specialised centres. Novel robotic approaches utilising the retroauricular and transoral routes for thyroidectomy have recently been described but further studies are required to establish their respective role in modern thyroid surgery.
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Affiliation(s)
- Patrick Aidan
- Department of Otorhinolaryngology and Head and Neck Surgery, American Hospital of Paris, Paris, France
| | - Asit Arora
- Department of Otorhinolaryngology and Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Balazs Lorincz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Neil Tolley
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - George Garas
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United .,Department of Surgical Research and Innovation, Royal College of Surgeons of England, London, United
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Kim EB, Cho JW, Lee YM, Sung TY, Yoon JH, Chung KW, Hong SJ. Postsurgical Outcomes and Surgical Completeness of Robotic Thyroid Surgery: A Single Surgeon's Experience on 700 Cases. J Laparoendosc Adv Surg Tech A 2018; 28:540-545. [PMID: 29346027 DOI: 10.1089/lap.2017.0597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Advanced technology and understanding of robotic surgical system have rendered robotic thyroid surgery more expanding. The aim of this study was to identify the periodic changes in postsurgical outcomes of robotic thyroid surgery performed by a single surgeon. METHODS We conducted a retrospective review of 700 robotic thyroid surgery cases using gasless trans-axillary approach. RESULTS All patients underwent successful operations without conversion to open surgery, and were mostly younger than 45 years, female, less-extended thyroid surgery and lymph node dissection, and thyroid cancer. The median follow-up period was 67 months (12-99 months). Regarding technical outcomes, the operation time declined steeply after 100 consecutive cases, and reached 120.0-132.7 minutes for thyroid lobectomy and 162.9-174.1 minutes for total thyroidectomy (TT). The most common complication was transient hypoparathyroidism (43.7%), whose incidence decreased steeply to a range of 9.1% to 25.0% after 300 consecutive cases. Regarding surgical completeness for thyroid cancer, an average of seven lymph nodes was retrieved through central compartment node dissection without fluctuation over time. The proportion of the patients with serum stimulated thyroglobulin levels <10 ng/mL at the time of radioactive iodine remnant ablation after TT and <1 ng/mL 6-12 months after the first remnant ablation ranged between 86.4%-100% and 66.7%-100%, respectively, without significant fluctuation. CONCLUSION For properly selected patients, robotic thyroid surgery is useful surgical option with reliable technical outcome and surgical completeness and cosmetic benefit.
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Affiliation(s)
- Eon-Bin Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Kim KN, Lee DW, Kim JY, Han KH, Tae K. Carbon dioxide embolism during transoral robotic thyroidectomy: A case report. Head Neck 2017; 40:E25-E28. [PMID: 29272052 DOI: 10.1002/hed.25037] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Carbon dioxide (CO2 ) embolism is a serious, although rare, complication of remote access thyroidectomy using CO2 insufflation. Recently, we encountered a case of CO2 embolism during transoral thyroidectomy, and present it here with a review of the literature. METHODS AND RESULTS A 59-year-old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO2 insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1-mg epinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. CONCLUSION The possibility of CO2 embolism during transoral thyroidectomy with CO2 insufflation should not be overlooked.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dong Won Lee
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyoung-Hee Han
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Song CM, Jang YI, Ji YB, Park JS, Kim DS, Tae K. Factors affecting operative time in robotic thyroidectomy. Head Neck 2017; 40:893-903. [PMID: 29206321 DOI: 10.1002/hed.25033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/07/2017] [Accepted: 10/25/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate factors related to operative time in robotic thyroidectomy. METHODS We retrospectively analyzed 240 patients who underwent robotic thyroidectomy. The total thyroidectomy cases and lobectomy cases were both categorized into those with long operative times (LOTs; upper 25% of cases) and those with short operative times (SOTs; lower 25%). RESULTS Among the total thyroidectomy cases, body mass index (BMI) ≥23 kg/m2 (hazard ratio [HR] 5.34; P = .008) and bilateral central neck dissection (CND; HR 14.92; P = .028) were more frequent in the LOT group in multivariate analysis. Among the lobectomy cases, BMI ≥23 kg/m2 (HR 12.92; P = .003) and unilateral CND (HR 21.38; P = .017) were the only independent risk factors for prolonged operative time. CONCLUSION Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.
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Affiliation(s)
- Chang Myeon Song
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Il Jang
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Krishnan G, Krishnan S. Transoral Robotic Surgery Total Laryngectomy: Evaluation of Functional and Survival Outcomes in a Retrospective Case Series at a Single Institution. ORL J Otorhinolaryngol Relat Spec 2017; 79:191-201. [PMID: 28609773 DOI: 10.1159/000464138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transoral robotic surgery total laryngectomy (TORS-TL) is a minimally invasive endoscopic surgical approach which can theoretically minimise the morbidity of large external incisions and limit dissection of tissue planes so as to reduce the risk of pharyngocutaneous fistulae related to poor tissue healing secondary to radiation soft tissue injury or malnutrition. The purpose of this paper was to report our experience with this uncommon surgical approach. METHODS A retrospective chart review was conducted at a single institution to evaluate the functional and survival outcomes of a series of patients who underwent TORS-TL. RESULTS TORS-TL was performed on 5 patients. Two patients had total laryngectomy for recurrent aspiration secondary to neurological disorders, 1 patient had an adenoid cystic carcinoma of the subglottis, 1 patient had a low-grade subglottic chondrosarcoma, and 1 patient had a T2 local recurrence of glottic squamous cell carcinoma following treatment with primary chemoradiotherapy. CONCLUSIONS TORS-TL is a feasible and safe treatment option with possible advantages for carefully selected patients in experienced hands.
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Affiliation(s)
- Giri Krishnan
- Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
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Pan JH, Zhou H, Zhao XX, Ding H, Wei L, Qin L, Pan YL. Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 2017; 31:3985-4001. [PMID: 28337546 DOI: 10.1007/s00464-017-5433-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the new technical alternative offered by the robotic surgery for minimally invasive thyroid surgery, the role of the robotic thyroidectomy (RT) in thyroid cancer has been highly disputed. This paper gives a systematic review and meta-analysis aiming to compare RT and open thyroidectomy (OT) based on the surgical outcomes and oncologic results. METHODS Relevant literature was searched from various databases up to July 2016, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of science and Clinical Trials. gov. Outcomes of interest included patient characteristics, surgical outcomes, adverse events and complications, recurrence rate, and surgical completeness. RESULTS The systematic review and meta-analysis were based on the 5200 cases selected from the twenty-three publications. RT was associated with an equivalent adverse event and complication rate including transient hypocalcemia, permanent hypocalcemia, transient hoarseness, permanent recurrent laryngeal nerve (RLN) palsy, transient hypoparathyroidism, permanent hypoparathyroidism, hematoma, postoperative bleeding, seroma, chyle leakage, the Voice Handicap Index-10 (VHI-10) score, as well as equivalent surgical completeness including postoperative radioactive iodine (RAI) ablation rate, number of RAI ablation sessions, mean total RAI ablation dose, mean stimulated Tg of postoperation RAI, and proportion of stimulated Tg < 1.0 ng/ml on first ablation. Moreover, RT had lesser blood loss (WMD - 1.47, p = 0.04), smaller number of retrieved lymph nodes (WMD - 1.21, p = 0.0002), a low level of swallowing impairment (WMD - 4.17, p < 0.00001), and better cosmetic satisfaction (OR 4.05, p < 0.00001). However, OT was associated with shorter operation time (WMD 69.80, p < 0.00001), less total drain amount (WMD 66.53, p < 0.0001), and lower postoperative serum Tg level (WMD 0.21, p < 0.00001). CONCLUSIONS RT is as safe as OT for the treatment of thyroid cancer. Based on the long-time follow-up and surgical completeness, the adverse events and complications, and recurrence rate of RT were comparable with OT. RT was associated with a significantly lesser blood loss, smaller number of retrieved lymph nodes, a lower level of swallowing impairment, and better cosmetic satisfaction. In contrast, OT was associated with shorter operation time, smaller total drain amount, and lower postoperative serum Tg level. Overall, randomized clinical trials and larger patient cohort with long-term follow-up are still essential to further demonstrate the value of the robotic approach.
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Affiliation(s)
- Jing-Hua Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hong Zhou
- Department of Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiao-Xu Zhao
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hui Ding
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Wei
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Qin
- Department of Histology and Embryology, Medical School of Jinan University, Guangzhou, 510632, China
| | - Yun-Long Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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