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Xu P, Fang Q, Mai J, Zhao Z, Cao F, Wu D, Liu X. Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications. BMC Surg 2024; 24:78. [PMID: 38431572 PMCID: PMC10909294 DOI: 10.1186/s12893-024-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Gasless robot-assisted transaxillary hemithyroidectomy (RATH) is regarded as an alternative surgical option for thyroid operations. However, the associated steep learning curve is a clinical concern. This study evaluated the learning curve of RATH for surgeons without experience of endoscopic surgery and the early surgical outcomes of RATH. METHODS We conducted a retrospective study of patients who underwent gasless RATH and conventional hemithyroidectomy (CH) at Sun Yat-sen University Cancer Center, Guangzhou, China, from June 2021 to August 2022. The learning curve and early surgical outcomes of gasless RATH were evaluated. And the early surgical outcomes of gasless RATH were compared to CH. RESULTS In total, 105 patients who underwent gasless RATH and 104 patients who underwent CH were matched and assessed. The cumulative sum techniques (CUSUM) analysis showed that the peak point of gasless RATH operative time occurred at the 31st case. No clear single peak was identified in the CUSUM plot for drainage amount and blood loss. No significant difference in perioperative complications was observed between these two groups. Moreover, the number of postoperative patients who got sense of thyroid area traction were fewer in the gasless RATH group (n = 11, 10.5%) than in the CH group (n = 32, 30.8%). CONCLUSION Gasless RATH can be considered as an alternative approach to the conventional open procedure, as it is an easy remote access technique, with shorter learning curves and certain advantage such as less sense of thyroid area traction.
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Affiliation(s)
- Pengfei Xu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Qi Fang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Junhao Mai
- Department of Breast and Thyroid Surgery, Guangzhou Panyu Central Hospital, 8 Fuyu East Road, Guangzhou, Guangdong, 511400, P.R. China
| | - Zheng Zhao
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Fei Cao
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Di Wu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
| | - Xuekui Liu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
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Nguyen VC, Song CM, Ji YB, Lee DW, Jeong JH, Tae K. Evaluation of the validity and reliability of a self-assessment questionnaire for cosmetic outcomes after thyroidectomy: a cross-sectional validation study. Eur Arch Otorhinolaryngol 2024; 281:1505-1513. [PMID: 38127099 DOI: 10.1007/s00405-023-08395-x] [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: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The Self-Assessment Questionnaire for Cosmetic Outcomes (SAQCO) was developed by us to evaluate the cosmetic outcome of patients after thyroidectomy. This study aimed to examine the reliability and validity of SAQCO. METHODS We analyzed the cosmetic outcomes of 368 patients who underwent thyroidectomy and completed the SAQCO 1 year after surgery. The one-dimensionality, reliability, and validity of SAQCO were assessed using factor analysis models, Cronbach's alpha, and test-retest statistics. The differences in cosmesis indices between patient characteristics and surgical parameters were analyzed through comparative and regression analyses. RESULTS The unidimensional convergence of SAQCO was examined. A Cronbach's alpha of 0.91, strong item-total correlation values (from 0.77 to 0.89), and a test-retest correlation value of 0.86 indicated the internal consistency and reliability of the SAQCO. The cosmesis index was significantly highest in the transoral (92.3 points) and transaxillary groups (90.9 points), followed by the postauricular (84.8 points) and transcervical groups (76.4 points). CONCLUSION This study examined the reliability and validity of the SAQCO and showed that it is a suitable questionnaire for assessing cosmetic satisfaction of patients after thyroidectomy. The transoral and transaxillary approaches yield significantly superior cosmetic results compared to the conventional transcervical and postauricular approaches.
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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
| | - 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
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, 42472, 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
| | - 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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He QQ, Ma YH, Zhu J, Wang M, Wang G, Zhou P, Wang D, Liu YX, Zheng LM, Zhuang DY, Yu F, Cao XJ, Liu CR, Li XL, Yue T, Wang YY, Jiang HP, Li YN, Xu J. Comparison of transoral vestibular robotic thyroidectomy with traditional low-collar incision thyroidectomy. J Robot Surg 2024; 18:88. [PMID: 38386236 DOI: 10.1007/s11701-024-01831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024]
Abstract
Transoral vestibular robotic thyroidectomy can really make the patient's body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.
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Affiliation(s)
- Qing-Qing He
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China.
| | - Yun-Han Ma
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Jian Zhu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Meng Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Gang Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Peng Zhou
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Dan Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Yong-Xiang Liu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Lu-Ming Zheng
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Da-Yong Zhuang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Fang Yu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Xian-Jiao Cao
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Chang-Rui Liu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Xiao-Lei Li
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Tao Yue
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Ying-Ying Wang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Hui-Ping Jiang
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Yan-Ning Li
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
| | - Jing Xu
- Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA Joint Logistics Support Force (Former Jinan Military General Hospital of People's Liberation Army), Jinan, 250031, Shandong, China
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Yuan Y, Pan B, Tang E, Mo H, Zhu J, Yi Z, Lu D, Yin T, Sun Y, Yin S, Yang Z, Zhang F. Surgical methods of total thyroidectomy for differentiated thyroid cancer: a systematic review and Bayesian network meta-analysis. Int J Surg 2024; 110:529-540. [PMID: 37916941 PMCID: PMC10793844 DOI: 10.1097/js9.0000000000000819] [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: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods. METHODS The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome. RESULTS Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92). CONCLUSIONS Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
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Affiliation(s)
- Yuquan Yuan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Bin Pan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Junping Zhu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Dengwei Lu
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Tingjie Yin
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Zeyu Yang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Fan Zhang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
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Del Rio P, Polistena A, Chiofalo MG, De Pasquale L, Dionigi G, Docimo G, Graceffa G, Iacobone M, Medas F, Pezzolla A, Sorrenti S, Spiezia S, Calò PG. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg 2023; 75:1393-1417. [PMID: 37198359 PMCID: PMC10435599 DOI: 10.1007/s13304-023-01522-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - M G Chiofalo
- Department Head and Neck, Thyroid Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - L De Pasquale
- Thyroid and Parathyroid Service, Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - G Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G Docimo
- Division of Thyroid Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - G Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplanatation, University of Bari "A. Moro", Bari, Italy
| | - S Sorrenti
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - S Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, Ospedale del Mare, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Papini P, De Palma A, Ginesini M, Rossi L, Fregoli L, Elisei R, Matrone A, Morganti R, Ambrosini CE, Materazzi G. Robot-assisted transaxillary surgery for thyroid cancer: Oncologic and surgical outcomes in long term follow-up. Int J Med Robot 2023:e2563. [PMID: 37642163 DOI: 10.1002/rcs.2563] [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: 03/16/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The use of robot-assisted transaxillary thyroidectomy (RATT) has rapidly spread in the last 2 decades, although it is mostly limited to Asian countries. METHOD We retrospectively enroled all patients with histologic diagnoses of thyroid cancer who underwent RATT at the University Hospital of Pisa from May 2012 to September 2020. RESULTS The study included 242 patients; 128 (47%) underwent total thyroidectomy and 114 (53%) underwent thyroid lobectomy, among which 28 patients (24.6%) required completion thyroidectomy. Radioactive iodine ablation therapy was required in 90 patients (37%). The complication rate was 5.3%. After a median follow-up of 38 months, an excellent response to therapy was achieved in 107 patients (74%), whereas the response was indeterminate in 12 (8%) and incomplete in 16 (11%). No local or distant relapses or increases in thyroglobulin or antibody levels were documented. CONCLUSIONS In experienced hands, RATT represents a valid option for the treatment of thyroid cancer in selected cases.
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Affiliation(s)
- Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Andrea De Palma
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Lorenzo Fregoli
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Carlo Enrico Ambrosini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
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Pai SN, Jeyaraman M, Jeyaraman N, Nallakumarasamy A, Yadav S. In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus 2023; 15:e43634. [PMID: 37719624 PMCID: PMC10504870 DOI: 10.7759/cureus.43634] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Hospital for Orthopedics, Sports Medicine, Arthritis, and Trauma (HOSMAT) Hospital, Bangalore, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Marciniak C, Bihain F, Caiazzo R, Brunaud L. Robotic thyroidectomy. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d'endocrinologie) and the SFMN (Société française de médecine nucléaire). J Visc Surg 2023:S1878-7886(23)00071-1. [PMID: 37150666 DOI: 10.1016/j.jviscsurg.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Transaxillary robotic thyroidectomy is hardly the approach of reference. It is occasionally proposed for carefully selected patients with a small-sized (2cm maximum), exclusively cervical unilateral nodule without lymph node involvement, in a small thyroid lobe (6cm maximum) in a thin individual wishing to avoid a cervical scar. Potential candidates must be informed on the risks specific to this technique and about the scarceness of evidence of its equivalence to cervicotomy in terms of quality of life and patient satisfaction. Shall be excluded from robotic surgery: malignant nodules (or nodules suspected of malignancy>2cm), cancers with microscopic nodal metastases, plunging goiter, patients with previous cervical surgery or overactive thyroid. Robotic thyroidectomy must be performed in centers with expertise in both thyroid surgery and robotic surgery.
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Affiliation(s)
- Camille Marciniak
- Lille University, CHU Lille, General and Endocrine Surgery Department, Lille, France.
| | - Florence Bihain
- University of Lorraine, CHRU Nancy (Brabois), Department of Visceral, Metabolic and Cancer Surgery (CVMC), Nancy, France
| | - Robert Caiazzo
- Lille University, CHU Lille, General and Endocrine Surgery Department, Lille, France
| | - Laurent Brunaud
- University of Lorraine, CHRU Nancy (Brabois), Department of Visceral, Metabolic and Cancer Surgery (CVMC), Nancy, France
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Xu C, Wu Z, Yin A, Zhang L. Hypercapnia and severe hyperkalemia following robot-assisted endoscopic thyroid surgery: A case report. Asian J Surg 2023:S1015-9584(23)00126-4. [PMID: 36732189 DOI: 10.1016/j.asjsur.2023.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Chang Xu
- Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhifang Wu
- Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Anqi Yin
- Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lidong Zhang
- Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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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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Tae K, Choi HW, Ji YB, Song CM, Park JH, Kim DS. Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study. Front Surg 2022; 9:985097. [PMID: 36303854 PMCID: PMC9592833 DOI: 10.3389/fsurg.2022.985097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Background The study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC). Methods We studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches. Results The transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms. Conclusion Transoral robotic SND is feasible with or without a postauricular incision.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea,Correspondence: Kyung Tae
| | - Hae Won Choi
- 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
| | - Chang Myeon Song
- 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
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Comparison of the Postoperative Outcomes of the Mini-Flap Bilateral Axillo-Breast Approach (BABA) and Conventional BABA Robot-Assisted Thyroidectomy. J Clin Med 2022; 11:jcm11164894. [PMID: 36013133 PMCID: PMC9410211 DOI: 10.3390/jcm11164894] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
Abstract
The bilateral axillo-breast approach (BABA) for robot-assisted thyroidectomy has some advantages over other minimally invasive thyroidectomies. However, some people do not consider this as a minimally invasive thyroidectomy because of the wider surgical skin flap. Thus, we devised mini-flap BABA robot-assisted thyroidectomy and analyzed the postoperative outcomes. The clinical records of 44 patients undergoing BABA robot-assisted thyroidectomy using a conventional flap or mini-flap were evaluated retrospectively. There were no significant group differences in clinicopathological characteristics. The operating and flap making times were shorter in the mini-flap group (206.18 ± 31.09 vs. 178.90 ± 34.43 min, p = 0.009; 38.85 ± 2.73 vs. 32.21 ± 8.62 min, p = 0.003, respectively). The total drainage amount was smaller in the mini-flap group (196.57 ± 81.40 vs. 150.74 ± 40.80 mL, p = 0.027). The numeric rating scale score and number of analgesics were lower at 2 h postoperatively in the mini-flap group (5.52 ± 0.87 vs. 4.57 ± 1.31, p = 0.006; 0.95 ± 0.22 vs. 0.65 ± 0.49, p = 0.012, respectively). There was no significant group difference in immediate oncological outcomes (p = 1.000). Mini-flap BABA robot-assisted thyroidectomy minimized the surgical flap and improved surgical outcomes. Therefore, it is a form of minimally invasive thyroidectomy. However, long-term follow-up of oncological outcomes is needed.
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Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach. J Clin Med 2021; 10:jcm10081707. [PMID: 33921046 PMCID: PMC8071380 DOI: 10.3390/jcm10081707] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy. METHODS From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed. RESULTS The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, p = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, p = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection. CONCLUSIONS BABA robotic completion thyroidectomy could be performed safely without completion-related complication.
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Liu PR, Lu L, Zhang JY, Huo TT, Liu SX, Ye ZW. Application of Artificial Intelligence in Medicine: An Overview. Curr Med Sci 2021; 41:1105-1115. [PMID: 34874486 PMCID: PMC8648557 DOI: 10.1007/s11596-021-2474-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
Artificial intelligence (AI) is a new technical discipline that uses computer technology to research and develop the theory, method, technique, and application system for the simulation, extension, and expansion of human intelligence. With the assistance of new AI technology, the traditional medical environment has changed a lot. For example, a patient's diagnosis based on radiological, pathological, endoscopic, ultrasonographic, and biochemical examinations has been effectively promoted with a higher accuracy and a lower human workload. The medical treatments during the perioperative period, including the preoperative preparation, surgical period, and postoperative recovery period, have been significantly enhanced with better surgical effects. In addition, AI technology has also played a crucial role in medical drug production, medical management, and medical education, taking them into a new direction. The purpose of this review is to introduce the application of AI in medicine and to provide an outlook of future trends.
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Affiliation(s)
- Peng-ran Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Lin Lu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Jia-yao Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Tong-tong Huo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Song-xiang Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zhe-wei Ye
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Tae K. Complications of Transoral Thyroidectomy: Overview and Update. Clin Exp Otorhinolaryngol 2020; 14:169-178. [PMID: 33211953 PMCID: PMC8111399 DOI: 10.21053/ceo.2020.02110] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/15/2020] [Indexed: 11/22/2022] Open
Abstract
Transoral thyroidectomy via the vestibular approach has become popular worldwide, with advantages including less surgical morbidity, excellent postoperative cosmesis, and superior functional voice outcomes. Several studies have reported that the surgical outcomes of the transoral approach were comparable to those of the conventional transcervical approach in selected patients. However, unusual complications, such as CO2 embolism, mental nerve injury, surgical space infection, skin perforation, burns, and trauma have been noted in transoral thyroidectomy. This paper aims to review and provide updated information on these complications and their management. Routine intraoperative neural monitoring is required to avoid laryngeal nerve palsy in the transoral approach. To prevent CO2 embolism, surgeons need to be careful not to injure the anterior jugular vein, and the CO2 insufflation pressure should be set as low as 4-6 mmHg. To avoid mental nerve injury, vestibular incisions should be placed in the safety zone, and dissection of the vestibular area and chin should be minimized. In conclusion, recognizing the possibility of complications and understanding their prevention and management are important for patient safety and the success of the transoral approach.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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