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Yu DY, Chang YW, Ku D, Ko SY, Lee HY, Son GS. Robotic thyroidectomy using gas-insufflation one-step single-port transaxillary (GOSTA) approach. Surg Endosc 2023; 37:8861-8870. [PMID: 37749201 DOI: 10.1007/s00464-023-10435-w] [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: 07/16/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND We conducted this study to report our novel robotic thyroidectomy using gas-insufflation one-step single-port transaxillary (GOSTA) approach and compare it with a conventional transaxillary (CTA) approach using a retraction method for intraoperative and postoperative outcomes. METHODS We retrospectively analyzed 354 patients who underwent robotic thyroidectomy between January 2019 and April 2023. Of these patients, 143 underwent the procedure through the GOSTA approach, which involves a small incision of 3 cm along the axillary folds with both arms down and a gas-insufflation, from skin flap creation to the completion of thyroidectomy as a one-step single-port procedure without the need for a retractor. The remaining 211 patients underwent the CTA approach. We analyzed the GOSTA approach and compared the surgical outcomes of the GOSTA (n = 100) and CTA (n = 167) approaches in patients with differentiated thyroid cancer who underwent thyroid lobectomy. RESULTS Out of the 143 patients who underwent the GOSTA approach, 12 underwent total thyroidectomy and 9 underwent lateral neck lymph node dissection with total thyroidectomy. GOSTA-thyroid lobectomy was performed on 122 patients; of these, 100 were diagnosed with differentiated thyroid carcinoma. A comparative study with the CTA approach was only conducted in patients who underwent thyroid lobectomy. No significant differences were found in operative time, hospital stay, or complications between the two groups. CONCLUSIONS Despite proceeding in one-step with a single smaller incision, from skin flap creation to the completion of thyroidectomy, the GOSTA approach is as feasible and safe as the CTA approach. Additionally, the GOSTA approach allows for thyroidectomy without using a retractor and reduces the workload for the surgeon and assistants.
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Affiliation(s)
- Da Young Yu
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Chang
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, Republic of Korea.
| | - Dohoe Ku
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Yeon Ko
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Yoon Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gil Soo Son
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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de Vries LH, Aykan D, Lodewijk L, Damen JAA, Borel Rinkes IHM, Vriens MR. Outcomes of Minimally Invasive Thyroid Surgery - A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:719397. [PMID: 34456874 PMCID: PMC8387875 DOI: 10.3389/fendo.2021.719397] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Conventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy. METHODS A systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques. RESULTS Out of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.
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Affiliation(s)
- Lisa H. de Vries
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dilay Aykan
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lutske Lodewijk
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Johanna A. A. Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Inne H. M. Borel Rinkes
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Menno R. Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Menno R. Vriens,
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Kasemsiri P, Trakulkajornsak S, Bamroong P, Mahawerawat K, Piromchai P, Ratanaanekchai T. Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery. BMC Surg 2020; 20:18. [PMID: 31996201 PMCID: PMC6988280 DOI: 10.1186/s12893-020-0685-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Background Trans-oral endoscopic thyroidectomy allows obviating scar of the neck that expects to gain quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore, this study compared the QOL outcomes, including cosmetic outcomes, between thyroidectomy by trans-oral endoscopy and conventional open surgery. Methods A study was conducted from January 30, 2017 to November 10, 2018. Thirty-two and 38 patients underwent trans-oral endoscopic thyroid surgery and conventional open surgery, respectively. Their quality of life was evaluated at 2, 6, and 12 weeks postoperatively using a thyroid surgery-specific questionnaire and a 36-item short-form questionnaire. Results Trans-oral endoscopic group, patients were younger and presented with smaller thyroid nodules (p < 0.05). Regarding surgical outcomes, there were no statistically significant differences between the two groups. Mean operative time was significantly longer in the trans-oral endoscopic group (p < 0.05). The quality of life parameters in the trans-oral endoscopic group was significantly better than in the conventional surgery group (p < 0.05). These parameters included reduction of physical activity, psychosocial impairment, the role of physic, and emotion at 2 weeks after surgery; swallowing impairment, psychosocial impairment, the role of physic, social function and mental health 6 weeks after surgery; tingling and feeling of vitality at 12 weeks after surgery. Cosmetic outcomes and overall satisfaction were significantly better in the trans-oral endoscopic group than in the conventional surgery group at all of our follow up times (p < 0.05). Conclusions The trans-oral endoscopic approach allows real scarless on the skin with better cosmetic and QOL outcomes. Trial registration This trial was retrospectively registered at the ClinicalTrial.gov (NCT03048539), registered on 4 March 2017.
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Affiliation(s)
- Pornthep Kasemsiri
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine at the Khon Kaen University, Khon Kaen, 40002, Thailand. .,Khon Kaen Head and Neck Oncology Research, Khon Kaen, Thailand. .,Srinagarind Minimally Invasive Surgery Center of Excellence, Khon Kaen, Thailand.
| | - Srongpaun Trakulkajornsak
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine at the Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Piyapong Bamroong
- Department of Otorhinolaryngology, Mukdahan Hospital, Mukdahan, Thailand
| | | | - Patorn Piromchai
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine at the Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Teeraporn Ratanaanekchai
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine at the Khon Kaen University, Khon Kaen, 40002, Thailand.,Khon Kaen Head and Neck Oncology Research, Khon Kaen, Thailand
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Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. Eur Arch Otorhinolaryngol 2016; 274:495-500. [DOI: 10.1007/s00405-016-4242-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Surgical Outcomes Comparison Between Endoscopic and Conventional Open Thyroidectomy for Benign Thyroid Nodules. J Craniofac Surg 2015; 26:e714-8. [DOI: 10.1097/scs.0000000000002223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Son SK, Kim JH, Bae JS, Lee SH. Surgical Safety and Oncologic Effectiveness in Robotic versus Conventional Open Thyroidectomy in Thyroid Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2015; 22:3022-32. [DOI: 10.1245/s10434-015-4375-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Indexed: 11/18/2022]
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Choi Y, Lee JH, Kim YH, Lee YS, Chang HS, Park CS, Roh MR. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 2014; 26:693-9. [PMID: 25473220 PMCID: PMC4252665 DOI: 10.5021/ad.2014.26.6.693] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Surgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy. OBJECTIVE To evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL. METHODS Patients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score. RESULTS Ninety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores. CONCLUSION Post-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar.
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Affiliation(s)
- Yuri Choi
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hye Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Linos D, Kiriakopoulos A, Petralias A. Patient Attitudes toward Transaxillary Robot-assisted Thyroidectomy. World J Surg 2013; 37:1959-65. [DOI: 10.1007/s00268-013-2090-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jackson NR, Yao L, Tufano RP, Kandil EH. Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck 2013; 36:137-43. [PMID: 23471784 DOI: 10.1002/hed.23223] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared the efficacy of robotic thyroidectomy via a gasless, axillary approach with conventional cervical and endoscopic techniques by meta-analysis. METHODS Articles were identified from the following keyword searches: robotic/robot-assisted thyroidectomy/thyroid surgery. Outcomes included operative time, hospital stay, complications, and cosmetic satisfaction after surgery. Between-group outcome differences were calculated using random-effects models. RESULTS In all, 87 publications were identified and 9 studies met inclusion criteria, totaling 2881 patients, 1122 of whom underwent robotic thyroidectomy. Those who underwent robotic surgery reported greater cosmetic satisfaction, with a pooled net mean difference of -1.35 (95% confidence interval [CI]: -1.69, -1.09). Robotic approach operative time was longer than that of the conventional approach (95% CI: 29.23, 54.87), with a trend to be shorter than the endoscopic approaches. Robotic surgery had similar risks to open and endoscopic approaches. CONCLUSIONS Our meta-analysis suggests that robotic thyroidectomy is as safe, feasible, and efficacious as conventional cervical and endoscopic thyroidectomy, showing superior cosmetic satisfaction than that of conventional thyroidectomy.
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Affiliation(s)
- Nicole R Jackson
- Department of Surgery, Division of Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, Louisiana; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Chen B, Wang Y, Xuan S, Zhang G, Hu S, Wachtel MS, Frezza EE. Endoscopic Thyroidectomy: The Development in a Chinese Center. J Laparoendosc Adv Surg Tech A 2012; 22:76-80. [PMID: 22044565 DOI: 10.1089/lap.2011.0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bo Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yanlei Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shijin Xuan
- Department of Thyroid Surgery, Jinan Central Hospital affiliated with Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mitchell S. Wachtel
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eldo E. Frezza
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 2010; 121:521-6. [PMID: 21344427 DOI: 10.1002/lary.21347] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 09/01/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the initial experience of gasless transaxillary robot-assisted endoscopic thyroid surgery in a series of patients and describe modifications of the technique for the North American patients, selection criteria, and other issues related to this technology. METHODS Retrospective review of the first 31 consecutive cases at a single institution. RESULTS Thirty-one patients underwent robotic thyroid surgery. Twenty thyroid lobectomies and 11 total thyroidectomies were performed. Improvements in the length of time to perform components of the procedure were noted from the early group of cases to later group of cases. No major or permanent complications occurred. CONCLUSIONS Robotic thyroid surgery is feasible in North American patients and can be safely performed. The procedure has potential complications and a definite learning curve exists for both surgeons and operating room staff. Training methods need to be validated to ensure safe adoption. More studies need to be performed to further evaluate the relative benefits of this technique.
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Affiliation(s)
- Ronald B Kuppersmith
- Texas Institute for Thyroid and Parathyroid Surgery, College Station, Texas 77845, USA.
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