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Shi XT, Shen J, Sun YY. Bibliometric analysis of research trends and hotspots on robot-assisted thyroid surgery. Medicine (Baltimore) 2024; 103:e37588. [PMID: 38579095 PMCID: PMC10994498 DOI: 10.1097/md.0000000000037588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Thyroid surgery involves the partial or complete removal of the thyroid gland and is a frequently performed surgical procedure. The adoption of robots, equipped with flexible and stable operating systems, has garnered acceptance among numerous surgeons for their capability to enable precise anatomical dissection in thyroid surgery. To gain a comprehensive insight into the present research landscape of robot-assisted thyroid surgery, this paper endeavored to conduct a thorough analysis of the field through bibliometric analysis. METHODS Relevant literature pertaining to robot-assisted thyroid surgery was retrieved from the Web of Science Core Collection (WOSCC) database, spanning from the inception of WOSCC to October 17, 2022. Visual analyses of publication quantity, distribution across countries/regions, institutions/organizations, authorship, journals, references, and keywords were conducted using Microsoft Excel, the bibliometrix package in R, Citescape, and VOSviewer software. RESULTS A total of 505 articles from 406 institutions in 36 countries/regions were included. South Korea emerged with highest number of publications. Notably, Professor CHUNG WY from Yonsei University in South Korea and the journal "Surg Endosc" stood out with the most publications. The current research landscape indicated significant interest in endoscopic thyroidectomy, surgical procedures, and the axillary approach. In addition, transoral robotic thyroidectomy (TROT), and learning curve (LC) were recognized as research frontiers, representing potential future hotspots in this field. CONCLUSION This study marks the first bibliometric analysis of the literature on robot-assisted thyroid surgery. The results highlight endoscopic thyroidectomy, surgical procedures, and the axillary approach as current research hotspots, with TROT and LC identified as potential future research hotspots.
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Affiliation(s)
- Xiao-Tong Shi
- Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Shen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Yu Sun
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kim JK, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Expansion of thyroid surgical territory through 10,000 cases under the da Vinci robotic knife. Sci Rep 2024; 14:7555. [PMID: 38555392 PMCID: PMC10981764 DOI: 10.1038/s41598-024-57163-2] [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: 12/02/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
With the progress of robotic transaxillary thyroid surgery (RTTS), the indications for this procedure have gradually expanded. This study presents the insights gained from performing 10,000 RTTS cases at a single institution, along with the expansion of indications over time. RTTS was performed on 10,000 patients using the da Vinci robot system between October 2007 and April 2023 at the Yonsei University Health System, Seoul, Korea. Among 10,000 patients, 9461 (94.0%) were diagnosed with thyroid cancer, whereas 539 (5.4%) had either a benign thyroid nodule or Graves' disease. Surgical procedures were performed using four-arm-based robots (da Vinci S, Si, or Xi) for 8408 cases (84.1%), with the remaining 1592 cases (15.9%) being performed using the da Vinci SP surgical robotic system. Notably, for 53 patients with nodules ≥ 5 cm, which were not included in the eligibility criteria of the previous study, RTTS was performed safely without significant complications. The most common postoperative complication was transient hypoparathyroidism (37.91%), and recurrence occurred in 100 patients with thyroid cancer (1.1%). In conclusion, RTTS appears safe and feasible from both surgical and oncological perspectives, and the spectrum of indications suitable for RTTS surgery is progressively expanding.
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Affiliation(s)
- Jin Kyong Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Gyeonggi-do, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Severance Hospital, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Woong Youn Chung
- Department of Surgery, Severance Hospital, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, 03722, South Korea.
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Lee J, Kim SH, Hong H. Comparison of Various Thyroidectomy Approaches: A Retrospective Cross-sectional Study. Surg Laparosc Endosc Percutan Tech 2023; 33:632-639. [PMID: 37934829 DOI: 10.1097/sle.0000000000001243] [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: 03/24/2023] [Accepted: 09/19/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND To avoid anterior neck scarring, numerous remote-access techniques to approach the thyroid gland (Remote access approach) have been described, including the transaxillary approach (TA), bilateral axillo-breast approach (BABA), and transoral robotic thyroidectomy (TORT). Popular worldwide, Remote access approachs have unique characteristics, advantages, and disadvantages. Herein, we investigated the characteristics of these distinct thyroidectomy approaches to aid surgeons in selecting the most appropriate method for patients. PATIENTS AND METHODS In total, 2351 cases of patients who underwent thyroidectomy between 2019 and 2021 were reviewed, including 1973, 281, 66, and 31 patients who underwent the conventional transcervical approach (TCA), TA, BABA, and TORT, respectively. Demographic characteristics, outcomes, and complications associated with these procedures were compared. The data were analyzed using the Student t test and the χ 2 test. Kruskal-Wallis and Mann-Whitney U tests were used if normality was not found. RESULTS Central lymph nodes (LNs) were retrieved mostly in patients who underwent lobectomy through TORT (mean: 9.4, P < 0.001). Metastatic central LNs were found more frequently (mean: 1.9 in lobectomy, 3.7 in total thyroidectomy) in patients who underwent lobectomy through TCA and TORT than in those who underwent lobectomy through other approaches (mean: 1.4 and 2.4, respectively, P < 0.05). BABA group patients had significantly fewer central LNs retrieved than those in other groups in lobectomy and total thyroidectomy (mean: 4.8 and 6.2, respectively, P < 0.05). Stimulated thyroglobulin levels did not differ among the 4 groups. The incidence of transient vocal cord palsy was statistically higher in the BABA group (5 cases, 7.5%) than in the other groups; however, all patients recovered. No difference was found in permanent vocal cord palsy (0.4% in TCA) or hypoparathyroidism (1.3% to 3.1%) among the 4 groups. The tumor size was significantly larger in the BABA group than in the other groups, with 10.6% of the patients having tumors larger than 4 cm. Total thyroidectomy was performed more frequently in the BABA group (51.8%) than in the other groups ( P = 0.005). The path of the external branch of the superior laryngeal nerve was more evident in TA, and the Cernea type was confirmed and preserved in 90.6% of TA cases. CONCLUSIONS Owing to the differences in working space and direction of the surgical field, TA was advantageous for preserving the external branch of the superior laryngeal nerve, whereas BABA was effective for total thyroidectomy and excision of large goiters. TORT was beneficial for central compartment neck dissection. These characteristics should be considered when choosing the best approach to improving cosmesis, function, and recurrence.
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Affiliation(s)
- Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Qin X, Luo J, Ma J, Cao X, Zhao J, Jiang J, Zhang Y, Zeng L, Fan L. Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery. Int J Surg 2023; 109:3974-3982. [PMID: 37755372 PMCID: PMC10720820 DOI: 10.1097/js9.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL). SUMMARY BACKGROUND DATA Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons. METHODS We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)]. RESULTS The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups. CONCLUSIONS RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Lingjuan Zeng
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
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Fu X, Ma Y, Hou Y, Liu Y, Zheng L. Comparison of endoscopic bilateral areolar and robotic-assisted bilateral axillo-breast approach thyroidectomy in differentiated thyroid carcinoma: a propensity-matched retrospective cohort study. BMC Surg 2023; 23:338. [PMID: 37940892 PMCID: PMC10633981 DOI: 10.1186/s12893-023-02250-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Robot-assisted and endoscopic thyroidectomy are superior to conventional open thyroidectomy in improving cosmetic outcomes and postoperative quality of life. The procedure of these thyroidectomies was similar in terms of surgical view, feasibility, and invasiveness. However, it remains uncertain whether the robotic-assisted bilateral axilla-breast approach (BABA) was superior to the endoscopic bilateral areolar approach (BAA) thyroidectomy. This study aimed to investigate the clinical benefit of these two surgical procedures to evaluate the difference between these two surgical procedures by comparing the pathological and surgical outcomes of endoscopic BAA and robotic-assisted BABA thyroidectomy in differentiated thyroid carcinoma. METHODS From November 2018 to September 2021, 278 patients with differentiated thyroid carcinoma underwent BABA robot-assisted, and 49 underwent BAA approach endoscopic thyroidectomy. Of these patients, we analyzed 42 and 135 patients of endoscopic and robotic matched pairs using 1:4 propensity score matching and retrospective cohort study methods. These two groups were retrospectively compared by surgical outcomes, clinicopathological characteristics, and postoperative complications. RESULTS The mean operation time was significantly longer in the EG than in the RG (p < 0.001), The number of retrieved lymph nodes was significantly lower in the ET group than in the RT group (p < 0.001). The mean maximum diameter of the thyroid was more expansive in the EG than in the RG (p = 0.04). There were no significant differences in the total drainage amount and drain insertion days between the two groups (p = 0.241, p = 0.316, respectively). Both groups showed that cosmetic satisfaction (p = 0.837) and pain score (p = 0.077) were similar. There were no significant differences in complication frequencies. CONCLUSION Robotic and endoscopic thyroidectomy are similar minimally invasive thyroid surgeries, each with its advantages, both of which can achieve the expected surgical outcomes. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Xiaokang Fu
- Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Yunhan Ma
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, No.25, Shifan Road, Tianqiao District, Jinan, 250031, China
| | - Yiqi Hou
- Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Yuan Liu
- Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Luming Zheng
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, No.25, Shifan Road, Tianqiao District, Jinan, 250031, China.
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Matteucci V, Fregoli L, Papini P, Rossi L, Matrone A, Miccoli M, Elisei R, Materazzi G. Comparison of surgical completeness in patients operated on conventional open total thyroidectomy (OT) or trans-axillary robot-assisted total thyroidectomy (RATT) by a single axillary approach. Updates Surg 2023:10.1007/s13304-023-01510-x. [PMID: 37160844 DOI: 10.1007/s13304-023-01510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/17/2023] [Indexed: 05/11/2023]
Abstract
Trans-axillary robot-assisted total thyroidectomy (RATT) is nowadays worldwide accepted but the completeness obtained by RATT is still debated. The Aim of this study was to compare the completeness and safety of RATT with conventional open thyroidectomy (OT). We enrolled patients with nontoxic multinodular goiter, cytologically indeterminate nodules and well differentiated thyroid cancer without local and/or distant metastasis. In all cases the biggest nodule should be < 6 cm. The surgical completeness was evaluated by means of serum thyroglobulin (hs-Tg) and neck ultrasound (nUS) performed three months postoperatively. 100 patients underwent either RATT or OT. The type of surgical procedure was chosen by patients. They were then divided in two subgroups based on benign or malignant histology. There were no significant differences in the postoperatively values of hs-Tg in patients operated with RATT or OT, both in benign and malignant subgroups. The post-operative thyroid remnant volume estimated by nUS was not significantly different between the two groups, both in benign and malignant subgroups. We also analyzed the difference of the volume of the thyroid remnant ipsilateral to the axillary access vs that of the remnant on the contralateral side and there was not significantly difference in both subgroups. RATT was demonstrated to determine a comparable surgical completeness as OT, both in benign and malignant thyroid diseases, with no differences in the prevalence of surgical complications. In our hands the surgical completeness of RATT by a single trans-axillary was satisfying.
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Affiliation(s)
- Valeria Matteucci
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Endocrine Surgery Unit, Pisa University Hospital, Via Paradisa 2, Edificio 30 E, 56100, Pisa, Italy.
| | - Lorenzo Fregoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Endocrine Surgery Unit, Pisa University Hospital, Via Paradisa 2, Edificio 30 E, 56100, Pisa, Italy
| | - Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Endocrine Surgery Unit, Pisa University Hospital, Via Paradisa 2, Edificio 30 E, 56100, Pisa, Italy
| | - Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Endocrine Surgery Unit, Pisa University Hospital, Via Paradisa 2, Edificio 30 E, 56100, Pisa, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, Endocrine Unit, Pisa University Hospital, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Endocrine Unit, Pisa University Hospital, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Endocrine Surgery Unit, Pisa University Hospital, Via Paradisa 2, Edificio 30 E, 56100, Pisa, Italy
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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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Martino B, Nitro L, De Pasquale L, Lozza P, Maccari A, Castellani L, Piazzoni M, Cardellicchio M, Bulfamante AM, Pipolo C, Felisati G, Saibene AM. Conversion rates in robotic thyroid surgery: A systematic review and meta‐analysis. Int J Med Robot 2022; 18:e2427. [PMID: 35644881 PMCID: PMC9539493 DOI: 10.1002/rcs.2427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Objective To define the conversion risk to open procedure during robot‐assisted thyroid surgery (RATS) identifying potential specific subclasses of procedures or accesses at higher conversion risk. Methods In a PRISMA‐compliant framework, all original prospective studies providing RATS conversion rates from multiple databases were pooled in a random‐effects meta‐analysis. Conversion rates were compared between different typologies of thyroid surgery and robotic access. Results 13 studies were deemed eligible. Four conversions from two studies were reported out of 398 procedures. No significant heterogeneity was observed (Cochran's Q p = 0.932; I2 = 0%). The pooled conversion rate was 1% (95% confidence interval, 0.1%–2%). The ANOVA‐Q test failed to show significant differences when comparing type of thyroid surgery or robotic access (respectively p = 0.766 and p = 0.457). Conclusion While the conversion rate appears consistently low across studies, prospective data collection and systematic reporting of procedural complications are required for framing high‐risk procedures and accesses.
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Affiliation(s)
- Barbara Martino
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Letizia Nitro
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service, Otolaryngology Unit, Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Paolo Lozza
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Alberto Maccari
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Luca Castellani
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Matilde Piazzoni
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Matteo Cardellicchio
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Carlotta Pipolo
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Giovanni Felisati
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit Santi Paolo e Carlo Hospital Department of Health Sciences Università Degli Studi di Milano Milan Italy
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Clinical Application of Pectoralis Nerve Block II for Flap Dissection-Related Pain Control after Robot-Assisted Transaxillary Thyroidectomy: A Preliminary Retrospective Cohort Study. Cancers (Basel) 2022; 14:cancers14174097. [PMID: 36077633 PMCID: PMC9454532 DOI: 10.3390/cancers14174097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary The main findings of the study are that pectoralis nerve block II (PECS II) may be a valuable analgesic option that alleviates flap dissection pain and stress during a robot-assisted transaxillary thyroidectomy (RATT) and reduces opioid consumption in the early recovery phase. Patients who received PECS II experienced a more comfortable recovery and required fewer painkillers. PECS II may serve as a valuable new pain relief modality in addition to the multimodal analgesic strategy for patients undergoing RATT. Although we have yet to investigate the optimal block duration, regions of sensory loss, optimal technique, and possible complications, our preliminary study suggests that PECS II reduces flap dissection pain and thus promotes recovery. Appropriate analgesia during RATT remains challenging, but is a key issue for postoperative recovery. A further prospective investigation is required to validate our results and establish the optimal pain control regimen for patients undergoing RATT. Abstract Few studies have examined the clinical utility of ultrasonography-guided pectoralis nerve block II (PECS II) during wide flap dissection of a robot-assisted transaxillary thyroidectomy (RATT). We assessed the ability of PECS II to reduce postoperative pain. We retrospectively reviewed 62 patients who underwent elective RATT from December 2021 to April 2022 at Seoul St. Mary’s Hospital (Seoul, Korea). The patients were divided into a block group (n = 28, 50.9%) and no-block group (n = 27, 49.1%). Pain was measured using a visual analog scale (VAS) at 4, 10, 20, 25, 35, and 45 h after surgery, and the requirements for rescue painkillers in the post-anesthesia care unit and ward were recorded. The VAS scores did not differ significantly between the two groups at 4 h postoperatively. The block group had significantly lower VAS scores at 10 and 25 h (p = 0.017 and p = 0.034, respectively). The block group required fewer painkillers in the post-anesthesia care unit than the no-block group, although the difference was not statistically significant in the ward. PECS II may serve as a new pain relief modality and valuable addition to the current multimodal analgesic strategy for patients undergoing RATT.
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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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Matteucci V, Bai D, Fregoli L, Papini P, Aghababyan A, Docimo G, Miccoli P, Materazzi G. The effect of robot-assisted transaxillary thyroidectomy (RATT) on body image is better than the conventional approach with cervicotomy: a preliminary report. Updates Surg 2020; 73:1169-1175. [PMID: 32399594 DOI: 10.1007/s13304-020-00785-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cosmetic satisfaction is not only based on the patient's perception of the scar itself but is also related to body image self-evaluation. Cosmetic superiority of Robot-assisted transaxillary thyroidectomy (RATT) over conventional thyroidectomy (CT) has not yet been clearly demonstrated. Aim of our study was to compare body image in patients undergoing CT versus RATT. METHODS The study included 160 (80 CT and 80 RATT) patients undergoing thyroidectomy between August 2014 and March 2018 at the Endocrine Surgery Department. The inclusion criteria were age 18 to < 60 years, female sex, thyroid volume < 30 mL, and nodule diameter < 5 cm. Scar length, operative time, and complications were analyzed. The body image questionnaire (BIQ) was used 3 months postoperatively. The Student t test was used for statistical analysis. RESULTS Age was lower in RATT group (38.2 vs 41.4 years) (P < 0.0001). The nodule diameter was larger in RATT group (27.1 vs 23.1 mm) (P = 0.028). Operative time was longer in RATT group (93.7 vs 47.6 min) (P < 0.0001). The scar was longer in RATT group (59.9 vs 37.7 mm) (P < 0.0001). The groups had similar complication rates. BIQ showed that RATT patients answered more favorably to question 2, "Do you feel the operation has damaged your body?" (P = 0.042) and to question 3, "Do you feel less attractive as a result of your treatment?" (P = 0.024). Also self-global satisfaction was better in RATT group (P = 0.019). CONCLUSIONS In our experience, RATT has a significantly better impact on body image than the conventional approach.
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Affiliation(s)
- Valeria Matteucci
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy
| | - Dan Bai
- College of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Lorenzo Fregoli
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy
| | - Piermarco Papini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy
| | - Aleksandr Aghababyan
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University L. Vanvitelli, Naples, Italy
| | - Paolo Miccoli
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy
| | - Gabriele Materazzi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa Hospital, University of Pisa, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy.
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12
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Kim K, Kang SW, Kim JK, Lee CR, Lee J, Jeong JJ, Nam KH, Chung WY. Robotic Transaxillary Hemithyroidectomy Using the da Vinci SP Robotic System: Initial Experience With 10 Consecutive Cases. Surg Innov 2020; 27:256-264. [DOI: 10.1177/1553350620909279] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Many studies have shown the operative feasibility and safety of robotic thyroidectomy. However, there is still a concern on the operative invasiveness of robotic thyroidectomy owing to the wide flap dissection. The aim of this study was to introduce our novel robotic technique, which can minimize the dissection extent using the da Vinci SP robotic system. Methods: Ten patients underwent robotic transaxillary thyroidectomy using the da Vinci SP robotic system between December 2018 and April 2019 at Yonsei University Hospital (Seoul, Korea). All procedures were performed successfully using the single-port robotic system. Results: All 10 patients were women and diagnosed with papillary thyroid carcinoma. The mean operative time was 148.7 ± 26.8 minutes. The mean operative time using the gasless method was shorter than that using the gas insufflation method (130.5 ± 14.1 vs 176.0 ± 12.8 minutes). All patients were discharged on the third day after operation without any complications. Conclusions: Robotic transaxillary thyroidectomy using the da Vinci SP robotic system is technically feasible and safe with a short length of incision, shorter than what earlier reported. To our knowledge, this is the first study to use a single-port robotic system for thyroidectomy. To verify the superior operative outcomes, further clinical trials are necessary.
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13
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Active surveillance of low-risk papillary thyroid carcinoma: a promising strategy requiring additional evidence. J Cancer Res Clin Oncol 2019; 145:2751-2759. [PMID: 31571010 DOI: 10.1007/s00432-019-03021-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC), the most common malignant tumor of the thyroid, has been criticized as overtreated by some researchers in recent years. Active surveillance (AS) was first proposed at Kuma Hospital in 1993, and popularized in other institutes ever since. We provide a brief review of low-risk PTC active monitoring studies to date, and discuss the advantages of AS and limitations of existing studies. RESULTS Most papillary thyroid microcarcinomas do not show significant growth or new lymph node metastasis in a 10-year AS period. Patients who undergo delayed surgery during AS generally have a good prognosis. Tumor progression correlates with age, calcification pattern, and Ki-67 positivity. Serum thyroid stimulating hormone concentration and pregnancy might also influence tumor progression in some studies. CONCLUSION Active surveillance for low-risk PTC has shown its safety and feasibility in certain populations. In the future, it is warranted to determine valuable tumor progression predictors and most suitable PTC patients for AS.
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Kong SH, Ryu J, Kim MJ, Cho SW, Song YS, Yi KH, Park DJ, Hwangbo Y, Lee YJ, Lee KE, Kim SJ, Jeong WJ, Chung EJ, Hah JH, Choi JY, Ryu CH, Jung YS, Moon JH, Lee EK, Park YJ. Longitudinal Assessment of Quality of Life According to Treatment Options in Low-Risk Papillary Thyroid Microcarcinoma Patients: Active Surveillance or Immediate Surgery (Interim Analysis of MAeSTro). Thyroid 2019; 29:1089-1096. [PMID: 31161898 DOI: 10.1089/thy.2018.0624] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: In this ongoing multicenter prospective cohort study on active surveillance (AS) in low-risk papillary thyroid microcarcinoma (PTMC), we aimed to compare the quality of life (QoL) of participants based on their choice of treatment, that is, AS or immediate surgery (OP). Methods: QoL of 203 participants who chose AS and 192 participants who underwent OP was evaluated using a thyroid-specific QoL questionnaire at diagnosis and during follow-up (median 8 months). Results: The mean ages of the participants in the AS and OP groups were 47.3 ± 11.7 and 45.6 ± 10.5 years (p = 0.138), respectively, and the mean tumor sizes were 5.7 ± 1.6 and 6.5 ± 2.1 mm (p = 0.065), respectively. At baseline, significantly better psychological health (7.1 ± 1.3 vs. 6.8 ± 1.6, p = 0.023) and overall health (6.8 ± 1.2 vs. 6.5 ± 1.3, p = 0.018) were observed in the AS group than in the OP group. During follow-up, significantly better physical (7.9 ± 1.1 vs. 7.4 ± 1.2, p < 0.001), psychological (7.4 ± 1.3 vs. 6.9 ± 1.6, p = 0.004), and overall health (6.9 ± 1.0 vs. 6.5 ± 1.1, p = 0.002) were observed in the AS group than in the OP group, whereas spiritual health was comparable between the two groups. Compared with the AS group, the OP group experienced more fatigue, changes in voice and appearance, less satisfaction, and low fear of recurrence. The self-assessed financial burden was similar at baseline and follow-up in both groups. Conclusion: The QoL of PTMC patients is different according to the type of treatment. Better psychological health at baseline and physical and psychological health at follow-up were observed in the AS group than in the OP group. However, studies with longer follow-up periods are needed.
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Affiliation(s)
- Sung Hye Kong
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Junsun Ryu
- 2Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Min Joo Kim
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Sun Wook Cho
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Young Shin Song
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Ka Hee Yi
- 4Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Do Joon Park
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- 5Korea National Institute of Health, Cheongju, Republic of Korea
| | - Yul Hwangbo
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
- 6Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - You Jin Lee
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
- 6Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Kyu Eun Lee
- 7Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Kim
- 7Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Woo-Jin Jeong
- 8Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun-Jae Chung
- 9Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Jeong Hun Hah
- 9Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - June Young Choi
- 10Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang Hwan Ryu
- 2Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yuh-Seog Jung
- 2Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jae Hoon Moon
- 11Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Kyung Lee
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
- 6Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Young Joo Park
- 1Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
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Detailed comparison of robotic and endoscopic transaxillary thyroidectomy. Asian J Surg 2019; 43:234-239. [PMID: 30902503 DOI: 10.1016/j.asjsur.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/15/2019] [Accepted: 02/27/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Robotic thyroidectomy is increasingly used for patients with papillary thyroid carcinoma (PTC). We compared the differences between robotic and endoscopic transaxillary thyroidectomy with regard to surgical procedures. METHODS This retrospective study enrolled 40 patients with PTC who underwent robotic hemithyroidectomy (robot group) using the Da Vinci S system and 37 patients (endoscopic group) who underwent endoscopic hemithyroidectomy. Video files of surgery for all patients were analyzed to compare the operation procedures: (flap creation, docking [only for robot group], dissection of the superior pole, dissection of the inferior pole, identification of parathyroid glands [PTGs] and the recurrent laryngeal nerve [RLN], dissection of the thyroid along the trachea, bleeding control, application of a drain, and wound closure). The duration of each procedure and the clinicopathological characteristics were analyzed. RESULTS Procedure time for patients in the robot group was shorter for inferior pole dissection and for identification of the PTGs and RLN (37.5 min vs. 50.5 min, p = 0.008). Mean total operative times for the two groups were comparable (153.0 min vs. 150.2 min, p = 0.732); however, excluding the docking procedure, operation time was shorter for the robot group (133.3 min vs. 150.2 min, p = 0.038). The number of sacrificed PTGs was also significantly smaller in the robot group (0.35 ± 0.53 vs. 0.65 ± 0.68, p = 0.036). CONCLUSION Compared to endoscopic thyroidectomy, robotic transaxillary thyroidectomy involved a shorter time for inferior pole dissection and PTGs and RLN identification; moreover, more PTGs were spared using this procedure.
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Transoral vestibule approach for thyroid disease: a systematic review. Eur Arch Otorhinolaryngol 2018; 276:297-304. [PMID: 30460401 DOI: 10.1007/s00405-018-5206-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/09/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Transoral endoscopic/robotic thyroidectomy vestibule approach (TOETVA/TORTVA) is a novel technology that has been proposed for the treatment of thyroid disease. Its adoption has increased because of its satisfying cosmetic effects. The primary aim of this systematic review was to assess the feasibility and safety of this approach, and the secondary aim was to discuss the indications for this technology. MATERIALS AND METHODS According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched Pubmed, Embase and the Cochrane databases for published studies on the feasibility and safety of TOETVA or TORTVA. RESULTS 11 articles containing 864 patients met the inclusion criteria after full-text screening, of which two were reports of randomized controlled trial (RCT), two were retrospective cohort studies and the remaining seven studies were case series. Only studies that evaluated the feasibility and safety of this approach were included. TOETVA/TORTVA was successfully performed in 857 out of the 864 cases (99.2%). The mean operative time ranged from 60.4 to 265.4 min. In most articles, blood loss was less than 50 mL and the mean hospital stay ranged from 1.1 to 8.2 days. The safety outcomes were presented in all articles. The total incidence of adverse events was 14.5%, of which the main complications were transient hypoparathyroidism (5.6%) and transient recurrent laryngeal nerve (RLN) injury (3.1%). CONCLUSIONS This review preliminarily suggests that TOETVA or TORTVA could be an effective and safe treatment for thyroidectomy. Due to the small sample size and low level of evidence, further large-scale, well-designed RCTs are required to validate our findings.
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17
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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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18
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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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An JS, Kim HG, Paek SH, Lee JW, Woo J, Kwon H, Lim W, Moon BI, Paik NS. Endoscopic Thyroidectomy Via the Cervico-axillary Approach for Thyroid Cancer: Initial Experience in a Single Institute. ACTA ACUST UNITED AC 2017. [DOI: 10.16956/kjes.2017.17.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jeong Shin An
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyun Goo Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Se Hyun Paek
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jun Woo Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Juhyun Woo
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Woosung Lim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea
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Jia G, Tian Z, Xi H, Feng S, Wang X, Gao X. Comparison of the breast and areola approaches for endoscopic thyroidectomy in patients with microcarcinoma. Oncol Lett 2016; 13:231-235. [PMID: 28123546 PMCID: PMC5245095 DOI: 10.3892/ol.2016.5439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/27/2016] [Indexed: 11/06/2022] Open
Abstract
The safety, advantages and disadvantages of thyroidectomy for microcarcinoma through the areola approach and breast approach were compared. Fifty patients diagnosed with thyroid microcarcinoma in our department from January 2014 to June 2015 were selected. The areola approach was carried out for 21 patients whereas the breast approach for 29 patients. Endoscopic thyroid lobectomy, isthmus resection and dissection of central group lymph nodes was performed. The clinical outcomes of the two surgical approaches were compared. Comparing operating time, blood loss during surgery, number of lymph node dissections, postoperative hospitalization time and surgical complications between the surgical approaches, there were no significant differences (P>0.05). Comparing patient satisfaction of cosmetic results from the incisions, the difference was statistically significant (P<0.05). Endoscopic thyroidectomy via areola approach and breast approach have equal curative effects for the treatment of thyroid microcarcinoma. However, the areola approach can achieve better cosmetic results and is a safe and ideal surgical method, that we recommend be widely used.
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Affiliation(s)
- Gaolei Jia
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Zhilong Tian
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Hailin Xi
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Su Feng
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Xiaokai Wang
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Xinbao Gao
- Department of Surgery for Vascular Thyroid and Hernia, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Kirchberg J, Mees T, Weitz J. [Robotics in the operating room : Out of the niche into widespread application]. Chirurg 2016; 87:1025-1032. [PMID: 27812814 DOI: 10.1007/s00104-016-0313-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the last few years robotic surgery has progressed from being confined to a small niche to a widespread application in routine visceral surgery; however, evidence for superiority of robotic surgery compared to laparoscopy from randomized studies with a sufficient number of patients is still lacking in most fields of visceral surgery. For complex operations that necessitate an extensive reconstruction phase, such as pancreatectomy, gastrectomy and esophagectomy, there is a potential benefit for the permanent and justified use of robotic surgery. Even in operations where delicate nerve preparation and radical surgical resection are simultaneously necessary, such as rectal resection, robotic surgery may provide certain benefits. In the long term there is a great potential for the integration of innovative techniques, such as navigation or other medical imaging procedures into robotic surgery, which can currently only partially be estimated. Care must be taken to avoid premature euphoria; however, due to the assumed great potential there is an urgent need for randomized studies to evaluate the possible benefits of robotic surgical techniques in visceral surgery in order to generate evidence for the welfare of patients.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - T Mees
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Kim SK, Woo JW, Park I, Lee JH, Choe JH, Kim JH, Kim JS. Propensity score-matched analysis of robotic versus endoscopic bilateral axillo-breast approach (BABA) thyroidectomy in papillary thyroid carcinoma. Langenbecks Arch Surg 2016; 402:243-250. [PMID: 27774578 DOI: 10.1007/s00423-016-1528-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The da Vinci surgical robot system was developed to overcome the weaknesses of endoscopic surgery. However, whether robotic surgery is superior to endoscopic surgery remains uncertain. Therefore, the purpose of this study was to compare the surgical and oncologic outcomes between endoscopic and robotic thyroidectomy using bilateral axillo-breast approach (BABA). METHODS Between January 2008 and June 2015, papillary thyroid carcinoma patients who underwent thyroidectomy with central neck dissection using endoscopic (n = 480) or robotic (n = 705) BABA were primarily reviewed. We performed 1:1 propensity score matching and 289 matched pairs were yielded. RESULTS Operation time was significantly longer in the robotic thyroidectomy than in the endoscopic thyroidectomy (184.9 vs. 128.9 min, P < 0.001). A significantly higher number of central lymph nodes (CLNs) were resected in the robotic thyroidectomy than in the endoscopic thyroidectomy (5.3 vs. 4.4, P = 0.003). However, the incidence of other outcomes including hospital stay, postoperative duration, thyroglobulin level, radioactive iodine ablation, hemorrhage, chyle leakage, wound infection, recurrent laryngeal nerve injury, and loco-regional recurrence did not significantly differ between the endoscopic thyroidectomy and the robotic thyroidectomy. CONCLUSIONS Endoscopic thyroidectomy is comparable with robotic thyroidectomy in view of surgical complications and LRR. Because robotic thyroidectomy resected a larger number of CLNs than did endoscopic thyroidectomy, further long-term follow-up studies will be required to clarify the possible prognostic benefits of robotic thyroidectomy.
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Affiliation(s)
- Seo Ki Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jung-Woo Woo
- Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jun Ho Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves' Disease. World J Surg 2016; 40:498-504. [PMID: 26754077 DOI: 10.1007/s00268-016-3403-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is an ongoing debate about whether robotic thyroidectomy (RT) is appropriate for Graves' disease. The aim of this study was to compare the safety of bilateral axillo-breast approach (BABA) RT with that of open thyroidectomy (OT) in patients with Graves' disease. METHODS From January 2008 to June 2014, 189 (44 BABA RT and 145 OT) patients underwent total thyroidectomy for Graves' disease. Recurrence of Graves' disease, intraoperative blood loss, hospital stay, and complication rates including recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism were analyzed between BABA RT and OT groups, after propensity score matching according to age, gender, body mass index, surgical indication, the extent of operation, excised thyroid weight, and follow-up period. RESULTS No patient experienced recurrence of Graves' disease after median follow-up of 35.0 months. Intraoperative blood loss (151.8 ± 165.4 mL vs. 134.5 ± 75.4 mL; p = 0.534) and hospital stay (3.4 ± 0.7 day vs. 3.3 ± 0.7 day; p = 0.564) were not different between BABA RT and OT groups. Complication rates including transient RLN palsy (11.4 vs. 11.4%; p = 1.000), transient hypoparathyroidism (18.2 vs. 20.5%; p = 0.787), permanent RLN palsy (0 vs. 2.3%; p = 0.315), and permanent hypoparathyroidism (2.3 vs. 2.3%; p = 1.000) were also comparable between groups. CONCLUSIONS BABA RT for Graves' disease showed comparable surgical completeness and complications to conventional OT. BABA RT can be recommended as an alternative surgical option for patients with Graves' disease who are concerned about cosmesis.
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Song CM, Yun BR, Ji YB, Sung ES, Kim KR, Tae K. Long-Term Voice Outcomes After Robotic Thyroidectomy. World J Surg 2016; 40:110-6. [PMID: 26464152 DOI: 10.1007/s00268-015-3264-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term voice function after robotic thyroidectomy in comparison with conventional transcervical thyroidectomy. METHODS We prospectively evaluated the voice functions of 54 patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillary or axillo-breast approach and of 70 patients who underwent conventional thyroidectomy. Subjective voice symptom score (VSS) was evaluated in questionnaires before thyroidectomy and then at 3, 6, 12, and 24 months after surgery. Objective acoustic parameters analyzed during the same period included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, highest frequency, frequency and intensity range, and maximal phonation time. RESULTS At 3 months after surgery, VSS was better in the robotic group than in the conventional group. At 2 years after surgery, VSS had recovered to the pre-operative level in the robotic group, whereas it remained significantly worse at 2 years in the conventional group. The phonatory frequency range and highest frequency were significantly wider and higher, respectively, in the robotic group than the conventional group at 6, 12, and 24 months postoperatively.Within the robotic group, the frequency range and highest frequency recovered to pre-operative levels by 6 months, whereas in the conventional group they remained below the pre-operative levels at 2 years post-operatively. There were no differences in other acoustic parameters between the two groups of patients at any period. CONCLUSION Up to 2 years post-operatively, robotic thyroidectomy has advantages in terms of recovery of voice symptoms and acoustic parameters over conventional thyroidectomy.
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The Learning Curve for Robotic Thyroidectomy Using a Bilateral Axillo-Breast Approach From the 100 Cases. Surg Laparosc Endosc Percutan Tech 2016; 25:412-6. [PMID: 25730738 DOI: 10.1097/sle.0000000000000121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the learning curve for robotic thyroidectomy using a bilateral axillo-breast approach. METHODS We examined the first 100 robotic thyroidectomies with central lymph node dissection due to papillary thyroid cancer between April 2010 and August 2011. We evaluated the clinical characteristics, operative time, pathologic data, and complications. RESULTS Operative time was reduced significantly after 40 cases; therefore, the patients were divided into 2 groups: group A (1 to 40 cases) and group B (41 to 100 cases). The mean operative time in group A (232.6±10.0 min) was longer than that in group B (188.9±6.0 min) with statistical significance (P=0.001). Other data, including characteristics, drainage amount, hospital stay, retrieved lymph nodes, thyroglobulin, and complications, were not different between the 2 groups. The learning curves with lobectomy and total thyroidectomy were reached at the same time. CONCLUSIONS The learning curve for robotic thyroidectomy with central lymph node dissection using bilateral axillo-breast approach was 40 cases for beginner surgeons. Robotic total thyroidectomy was performed effectively and safely after experience with 40 cases, as with lobectomy.
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Tian F, Hong XF, Wu WM, Han XL, Wang MY, Cong L, Dai MH, Liao Q, Zhang TP, Zhao YP. Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg 2016; 103:1358-64. [PMID: 27480993 DOI: 10.1002/bjs.10220] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/16/2016] [Accepted: 04/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Enucleation of pancreatic neuroendocrine tumours (pNETs) via robotic surgery has rarely been described. This study sought to assess the safety and efficiency of robotic surgery for the enucleation of small pNETs. METHODS A comparison was conducted of enucleation of pNETs smaller than 2 cm by robotic or open surgery between January 2000 and May 2015. Propensity score matching was used to balance sex, age, BMI, tumour location and tumour diameter. Pathological results, safety-related outcomes (postoperative pancreatic fistula (POPF) rate, estimated blood loss, and short-term mortality and morbidity) and efficiency-related outcomes (duration of surgery and postoperative length of hospital stay) were compared between the groups. RESULTS A cohort of 120 patients with pNET were enrolled in the study (1 : 1 matched for open or robotic surgery, 60 per group). Ninety-three patients (77·5 per cent) had a grade 1 tumour and 114 (95·0 per cent) had an insulinoma. Robotic surgery had a conversion rate of 5 per cent (3 of 60), and was not associated with an increased POPF rate (10 per cent versus 17 per cent after open surgery; P = 0·283) or grade III-V surgical complications according to the Dindo-Clavien classification (3 versus 10 per cent respectively; P = 0·272). Estimated blood loss was reduced with the robotic approach (32·5 versus 80·0 ml in the open group; P = 0·008), as was duration of surgery (117 versus 150 min; P < 0·001). Length of hospital stay after surgery was similar in the two groups (12·0 versus 13·5 days respectively; P = 0·071). CONCLUSION Robotic surgery for enucleation of pNETs smaller than 2 cm did not increase POPF or major complication rates, and reduced the duration of surgery and estimated blood loss, compared with open surgery. REGISTRATION NUMBER NCT02125929 ( https://www.clinicaltrials.gov/).
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Affiliation(s)
- F Tian
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - X-F Hong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - W-M Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - X-L Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - M-Y Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - L Cong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - M-H Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - Q Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - T-P Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - Y-P Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
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Abstract
The incidence of thyroid cancer has abruptly increased recently, with a female predominance. Conventional thyroidectomy using transcervical incision inevitably leaves an unfavorable neck scar; therefore, various extracervical approaches have been introduced to improve cosmetic satisfaction after thyroidectomy. Several reports demonstrated that these extracervical approaches have advantages not only in terms of cosmesis but also in terms of surgical outcomes and postoperative functional preservation. The retroauricular approach has advantages as the dissection area is smaller than that in the transaxillary approach (TA) and surgical anatomy is familiar to the head and neck surgeons. In addition, there is no concern about paresthesia around the nipple or anterior chest, and surgical direction makes central neck dissection easier than with the other extracervical approaches. Herein, we aim to introduce the surgical procedure of retroauricular approach thyroidectomy and present our experiences of postoperative outcomes.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul 136-705, South Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul 136-705, South Korea
| | - Kwang-Yoong Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul 136-705, South Korea
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28
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Abstract
A robotic approach for thyroid surgery was developed to overcome the limitations of endoscopic thyroidectomy and provide many technical advantages. This approach facilitates the surgeon's control through a magnified three-dimensional view, decreased tremor, and freedom of motion with articulated instruments. Robotic thyroidectomy is safe and technically feasible in patients with well-differentiated, low-risk thyroid cancer. Furthermore, robotic thyroidectomy may become a good surgical alternative option for patients with more advanced thyroid cancer. Our modified bilateral axillo-breast approach (BABA) for central and lateral cervical neck lymph node (LN) dissection has yielded excellent surgical outcomes as an open procedure. The incorporation of robotics in thyroid cancer surgery will continue to evolve, and the surgical indications for robotic thyroidectomy will continue to expand. Further analyses that include long-term outcomes and randomized comparative trials remain important.
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Affiliation(s)
- Se Hyun Paek
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Ho Kang
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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29
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Lallemant B, Doucy S, Chambon G. Place de la chirurgie robot-assistée dans la prise en charge des pathologies thyroïdiennes. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Alkan U, Zarchi O, Rabinovics N, Nachalon Y, Feinmesser R, Bachar G. The cause of brachial plexopathy in robot-assisted transaxillary thyroidectomy-A neurophysiological investigation. Laryngoscope 2016; 126:2187-93. [PMID: 26774192 DOI: 10.1002/lary.25850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/26/2015] [Accepted: 12/01/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS During robot-assisted transaxillary thyroidectomy, the patient's arm is maintained in an overhead flexed position for a prolonged time, which poses a risk of postoperative brachial plexopathy. The aim of the study was to identify the causes of brachial plexopathy and to assess the benefit of intraoperative neurophysiological monitoring (IONM) in preventing positional brachial plexopathy in this setting. STUDY DESIGN Retrospective case series. METHODS The computerized database of a tertiary medical center was searched for all consecutive patients who underwent robot-assisted transaxillary thyroidectomy between 2012 and 2014. Clinical, operative, and outcome parameters were collected from the medical files. Findings were compared between patients operated with and without IONM. RESULTS The cohort included 30 patients, 14 operated with IONM and 16 without. Three events of impending brachial plexopathy were detected in the monitored group. The monitored group had significantly better shoulder movement (P = .003), a lower rate of hypoesthesia (P = .011), less pain (P = .001) in the early postoperative period than the nonmonitored group and higher quality of life in the early postoperative period (P = .012). The monitored group was significantly younger than the nonmonitored one (P = .02) and had a significantly larger diameter of thyroid nodule than the nonmonitored group (P = .043). CONCLUSIONS IONM during robot-assisted transaxillary thyroidectomy may improve short-term postoperative pain and shoulder movement and longer-term quality of life. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2187-2193, 2016.
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Affiliation(s)
- Uri Alkan
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Zarchi
- Intraoperative Neurophysiological Service, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Rabinovics
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Nachalon
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Feinmesser
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Robotic thyroid surgery for papillary thyroid carcinoma: lessons learned from 100 consecutive surgeries. Surg Laparosc Endosc Percutan Tech 2015; 25:27-32. [PMID: 25635671 DOI: 10.1097/sle.0b013e3182a2b0ae] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of robotic thyroidectomy using the da Vinci surgical system. PATIENTS AND METHODS Between July 2008 and April 2011, the data revealed an initial series of 100 consecutive patients who underwent robotic thyroidectomy with the da Vinci-S surgical system using the bilateral axillo-breast approach for thyroid cancer. Prospectively collected data were analyzed retrospectively. RESULTS There were 88 cases of total thyroidectomy, 11 cases of lobectomy, and 1 case of total thyroidectomy with modified radical neck dissection. There was no conversion. The mean total operation time was 287.15±45.19 minutes for total thyroidectomy and 236.27±48.98 minutes for lobectomy. Nineteen patients experienced transient hypocalcemia and 3 patients experienced transient vocal fold palsy. All of the patients recovered within 3 months. CONCLUSIONS Robotic thyroid surgery for patients with thyroid malignancy is safe and results in fewer postoperative complications than open thyroid surgery.
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Byeon HK, Kim DH, Chang JW, Ban MJ, Park JH, Kim WS, Choi EC, Koh YW. Comprehensive application of robotic retroauricular thyroidectomy: The evolution of robotic thyroidectomy. Laryngoscope 2015; 126:1952-7. [PMID: 26525822 DOI: 10.1002/lary.25763] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 08/17/2015] [Accepted: 10/05/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS As an evolvement of the robotic application to the thyroidectomy, we sought to seek the potential role of robotic thyroidectomy with the retroauricular (RA) approach prior to future comparative study between RA and transaxillary thyroidectomy. This study aims to verify the surgical feasibility of robotic RA thyroidectomy. STUDY DESIGN Case series with planned data collection. METHODS A total of 87 patients who underwent robotic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January 2013 to May 2014 were retrospectively reviewed and analyzed. RESULTS All robotic surgeries via RA approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars. CONCLUSION Robotic RA thyroidectomy is technically feasible and safe, with satisfactory cosmetic results for patients where indicated. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1952-1957, 2016.
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Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kandil E, Hammad AY, Walvekar RR, Hu T, Masoodi H, Mohamed SE, Deniwar A, Stack BC. Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes. Surg Innov 2015; 23:317-25. [PMID: 26525401 DOI: 10.1177/1553350615613451] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods A systematic search of the online data bases was done using the following (MeSH) terms "robotic surgery," "robotic thyroidectomy," "robot-assisted thyroidectomy," and "robot-assisted thyroid surgery." Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion Robotic thyroid surgery is as safe, feasible and provides similar periperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach.
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Affiliation(s)
- Emad Kandil
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Rohan R Walvekar
- Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health, New Orleans, LA, USA
| | - Hammad Masoodi
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Ahmed Deniwar
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Brendan C Stack
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Kang SW, Chung WY. Transaxillary single-incision robotic neck dissection for metastatic thyroid cancer. Gland Surg 2015; 4:388-96. [PMID: 26425451 DOI: 10.3978/j.issn.2227-684x.2015.06.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In head and neck area, neck dissection (ND) is one of the most complex and precision-needed procedure. The long cervical scar and post-operative neck discomfort have been also inevitable brands after this procedure. Heretofore, few dare to try endoscopic surgical technique to the ND mainly due to its complexity and jeopardy of complication. Although, there have been several reports about the endoscopic approaches for functional ND or ND, they had so many technical and instrumental limitations. The dexterities of the surgical robotics have advanced the techniques of endoscopic surgery, and have facilitated the most precise and delicate endoscopic surgical procedure in head and neck area. The technical feasibility and early surgical outcomes of robotic ND using the transaxillary approach for the management of metastatic thyroid cancer have already been reported as satisfactory. Robotic ND can allow complete compartment-oriented lymph node (LN) dissection without any fatal complications, or compromising oncologic principles. We previously described a novel method of robotic thyroidectomy with ND using a gasless transaxillary approach for metastatic thyroid cancer, and here, we firstly introduce a less invasive robotic procedure which has been modified from the original one, which we refer to as the transaxillary single-incision robotic ND.
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Affiliation(s)
- Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
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35
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Abstract
Recent technological advances have led to a rapid progress in endocrine surgery. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising approaches. Its main advantages are improved cosmetic outcome, avoiding cervical incisions, increased patient satisfaction, improved visualization, arms articulations, eliminating surgeon's natural tremor, thereby increasing precision. The main disadvantages are longer operative time, and increased cost compared to conventional thyroidectomy, as well as potential injuries to the brachial plexus, skin flap, esophagus, and trachea. Large-scale studies, mainly from South-Korea, have proved that in skilled hands, RATS is a safe alternative to conservative thyroidectomy and should be presented to patients with aesthetic concerns. As with any new emerging technique, careful patient selection is crucial, and further evidence must be sought to confirm its indications.
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Affiliation(s)
- Naomi Rabinovics
- 1 Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; 2 Department of ENT Head and Neck Surgery, The American Hospital, Paris, France
| | - Patrick Aidan
- 1 Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; 2 Department of ENT Head and Neck Surgery, The American Hospital, Paris, France
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36
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Sharma A, Albergotti WG, Duvvuri U. Applications of Evolving Robotic Technology for Head and Neck Surgery. Ann Otol Rhinol Laryngol 2015; 125:207-12. [PMID: 26391091 DOI: 10.1177/0003489415606448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assess the use and potential benefits of a new robotic system for transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy in a cadaver dissection. METHODS Three previously described robotic procedures (transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy) were performed in a cadaver using the da Vinci Xi Surgical System. Surgical exposure and access, operative time, and number of collisions were examined objectively. RESULTS The new robotic system was used to perform transoral radical tonsillectomy with dissection and preservation of glossopharyngeal nerve branches, transoral supraglottic laryngectomy, and retroauricular thyroidectomy. There was excellent exposure without any difficulties in access. Robotic operative times (excluding set-up and docking times) for the 3 procedures in the cadaver were 12.7, 14.3, and 21.2 minutes (excluding retroauricular incision and subplatysmal elevation), respectively. No robotic arm collisions were noted during these 3 procedures. The retroauricular thyroidectomy was performed using 4 robotic ports, each with 8 mm instruments. CONCLUSIONS The use of updated and evolving robotic technology improves the ease of previously described robotic head and neck procedures and may allow surgeons to perform increasingly complex surgeries.
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Affiliation(s)
- Arun Sharma
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University, Springfield, Illinois, USA
| | - W Greer Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Department of Otolaryngology, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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Abstract
BACKGROUND More than 8,000 cases of robotic thyroidectomy (RoT) were performed in South Korea from 2007 to 2011 using either a transaxillary approach (TAA) or a bilateral axillo-breast approach (BABA). However, there is no consensus regarding patient selection for RoT. This study used a web-based survey questionnaire to examine the current status of RoT in South Korea. METHODS Thirty-two of 50 surgeons (64.0 %) who had performed RoT in South Korea participated in the web-based survey in August 2011. The questionnaires comprised four main domains: surgeon characteristics, surgical approach, patient selection, and future prospects. RESULTS In terms of surgical approach, 43.8 % respondents used the TAA method and 53.1 % used the BABA method. The main advantage cited by surgeons using the TAA method was that it made lateral lymph node dissection easier (35.7 %), whereas those using the BABA method cited more cosmesis (100 %) and ease of performing a contralateral thyroidectomy (88.2 %). Papillary thyroid cancer ≤2 cm (65.3 %), intracapsular lesion (76.7 %), nonposterior location (53.6 %), and no clinical evidence of lateral lymph node metastasis (76.7 %) were cited as main indications for RoT. Of respondents, 87.5 % agreed that RoT would play a future role as a treatment modality for thyroid disease. CONCLUSIONS Opinions differed regarding the advantages and disadvantages of two approaches for RoT. This may be due to differences in surgical procedure itself between two approach methods. Accumulation of RoT surgeon's experiences might establish consensus regarding patient selection and indications for the RoT will need to be further investigated.
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A prospective 1-year comparative study of transaxillary total thyroidectomy regarding functional outcomes: Is it really promising? Surg Endosc 2015; 30:1599-606. [PMID: 26194250 DOI: 10.1007/s00464-015-4386-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate postoperative voice outcomes and functional parameters in total thyroidectomy via a transaxillary (TA) approach. METHODS Seventy-six patients who underwent total thyroidectomy via a TA approach (TA group) were included. A total of 204 patients who underwent conventional open total thyroidectomy (conventional group) in the same time period were analyzed as a control group. All patients underwent prospective functional evaluations before surgery and at 1 week and 1, 3, 6, and 12 months postoperatively using a comprehensive battery of functional assessments. RESULTS There was no conversion to conventional open thyroidectomy in the TA group. Operation time and the amount of drainage were significantly higher in the TA group than in the conventional group (p < 0.001 and p = 0.033, respectively), while vocal cord paralysis, hypoparathyroidism, and hematoma were not different among two groups (p = 0.215, 0.290, and 0.385, respectively). Regarding GRBAS, the TA group showed a more aggravated tendency postoperatively, although statistical significance was attained only at postoperative 6 months (p = 0.043). The voice handicap index abruptly increased postoperatively in the TA group, showing significant differences with the conventional group at postoperative 1 week and 1 month (p < 0.001 and p = 0.001, respectively). Fundamental frequency and maximal vocal pitch did not significantly change postoperatively in either group. The conventional group showed a more rapid decline in pain than the TA group, and paresthesias on the neck and chest were more aggravated in the TA group during the early postoperative period. The dysphagia handicap index was higher in the TA group, while cosmesis was better in the TA group at all postoperative periods. CONCLUSIONS Although cosmetic outcome was better with the TA approach, the longer operation time, aggravated subjective voice outcomes, paresthesia, and swallowing function need to be considered in selecting the operative approach.
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Endoscopic retroauricular thyroidectomy: preliminary results. Surg Endosc 2015; 30:355-65. [PMID: 25875088 DOI: 10.1007/s00464-015-4202-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We sought to seek the potential role of endoscopic thyroidectomy with the retroauricular (RA) approach prior to future comparative study with the robotic RA thyroidectomy. Therefore, this study aims to verify the surgical feasibility of endoscopic RA thyroidectomy. METHODS Eighteen patients who underwent endoscopic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January to December 2013 were retrospectively reviewed and analyzed. RESULTS All endoscopic operations via RA or modified facelift approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars. CONCLUSION Endoscopic RA thyroidectomy is technically feasible and safe with satisfactory cosmetic results for patients where indicated.
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Kiong KL, Iyer NG, Skanthakumar T, Ng JCF, Tan NC, Tay HN, Tan HK. Transaxillary thyroidectomies: a comparative learning experience of robotic vs endoscopic thyroidectomies. Otolaryngol Head Neck Surg 2015; 152:820-6. [PMID: 25829387 DOI: 10.1177/0194599815573003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Robotic and endoscopic approaches have become more accepted in thyroid surgery, with current literature documenting the experience of high-volume centers. We adopted both approaches concurrently, and this series presents our initial experience to assess the more practical option for low- to moderate-volume centers starting out with transaxillary thyroidectomies. STUDY DESIGN Case series with chart review. SETTING Tertiary academic center. SUBJECTS AND METHODS Over a period of 4 years, 101 patients underwent transaxillary thyroidectomies, of whom 48 underwent robotic thyroidectomy and 53 underwent endoscopic thyroidectomy. Data analysis includes patient characteristics, procedure time, thyroid pathology, and postoperative complications. A survey was conducted among surgeons to assess the subjective experience. RESULTS Endoscopic hemithyroidectomies had a significantly shorter duration of operation (145.8 minutes) vs that of robotic hemithyroidectomies (193.6 minutes), P < .001. The mean time taken for the first 5 hemithyroidectomies vs the last 5 hemithyroidectomies showed a greater drop in the endoscopic group (49.1%) vs the robotic group (18.6%). There were 2 cases of transient recurrent laryngeal nerve injury. In the surgeon survey, the endoscopic technique was perceived to have less need for peripheral support, while the robotic technique was preferred for its shorter learning curve. CONCLUSION In terms of outcome, both techniques are comparable at least in the initial phase. Based on our early experience, the endoscopic technique may be less intuitive with a longer learning curve, although at steady state, it may be the quicker procedure. This is relevant for low- to moderate-volume centers starting their transaxillary thyroidectomy program.
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Affiliation(s)
| | | | | | | | | | - Hin Ngan Tay
- Singapore General Hospital, SingHealth, Singapore
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Melotti G, Piccoli M, Mullineris B, Varoli M, Colli G, Gozzo D, Smerieri N, Surendra N, Caruso A, Conigliaro R, Frazzoni M. Zenker diverticulectomy: first report of robot-assisted transaxillary approach. J Robot Surg 2014; 9:75-8. [DOI: 10.1007/s11701-014-0492-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Byeon HK, Holsinger FC, Tufano RP, Chung HJ, Kim WS, Koh YW, Choi EC. Robotic Total Thyroidectomy with Modified Radical Neck Dissection via Unilateral Retroauricular Approach. Ann Surg Oncol 2014; 21:3872-5. [DOI: 10.1245/s10434-014-3896-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 11/18/2022]
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Duke WS, Bush CM, Singer MC, Haskins AD, Waller JL, Terris DJ. Incision Planning in Thyroid Compartment Surgery: Getting it Perfect. Endocr Pract 2014; 21:107-14. [PMID: 25148816 DOI: 10.4158/ep14170.or] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated changes in thyroid compartment incision site locations with patient positioning to define a reliable method for placing the scar in the optimal vertical location. METHODS The optimal incision location was marked with the patient sitting upright before surgery. The distance from the sternal notch to this mark was measured with the patient in the upright, supine, and final surgical positions. RESULTS Complete data were available for 104 procedures. The mean distances from the sternal notch to the incision site were 4.8, 21.5, and 31.9 mm in the sitting, supine, and surgical positions, respectively. Each of these distances were significantly different from one another (P<.0001) and were independent of patient age, sex, body mass index (BMI), or height. CONCLUSIONS Cutaneous cervical landmarks migrate significantly during patient positioning. Marking the thyroid compartment incision site while the patient is in an upright position results in a more predictable final scar location.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology - Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Carrie M Bush
- Department of Otolaryngology - Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Michael C Singer
- Department of Otolaryngology - Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Angela D Haskins
- Department of Otolaryngology - Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Georgia Regents University, Augusta, Georgia
| | - David J Terris
- Department of Otolaryngology - Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
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Factors contributing to surgical outcomes of transaxillary robotic thyroidectomy for papillary thyroid carcinoma. Surg Endosc 2014; 28:3134-42. [DOI: 10.1007/s00464-014-3567-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Abstract
Since its introduction, robotic surgery has been rapidly adopted to the extent that it has already assumed an important position in the field of general surgery. This rapid progress is quantitative as well as qualitative. In this review, we focus on the relatively common procedures to which robotic surgery has been applied in several fields of general surgery, including gastric, colorectal, hepato-biliary-pancreatic, and endocrine surgery, and we discuss the results to date and future possibilities. In addition, the advantages and limitations of the current robotic system are reviewed, and the advanced technologies and instruments to be applied in the near future are introduced. Such progress is expected to facilitate the widespread introduction of robotic surgery in additional fields and to solve existing problems.
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Affiliation(s)
- Se-Jin Baek
- Department of Surgery; Yonsei University College of Medicine; Seoul South Korea
| | - Seon-Hahn Kim
- Department of Surgery; Korea University College of Medicine; Seoul South Korea
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Lang BHH, Wong CKH, Tsang JS, Wong KP. A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy. J Surg Res 2014; 191:389-98. [PMID: 24814766 DOI: 10.1016/j.jss.2014.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/19/2014] [Accepted: 04/09/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite its feasibility, using the da Vinci robot in remote-access thyroidectomy remains controversial. This meta-analysis compared surgical and oncological outcomes between robotic-assisted thyroidectomy (RT) and non-robotic endoscopic thyroidectomy (ET). METHODS A systematic review was performed to identify studies comparing outcomes between RT and ET. Outcomes included operating time, drain output, complications, number of central lymph nodes retrieved, and preablation stimulated thyroglobulin level. A random-effects model was used. RESULTS Six studies were eligible. Of the 3510 patients, 2167 (61.7%) underwent RT whereas 1343 (38.3%) underwent ET. Despite a higher drain output (185.8 mLs versus 173.3 mLs, P = 0.019), RT had fewer temporary recurrent laryngeal nerve injury (2.6% versus 3.3%, P = 0.035) and shorter length of hospital stay (3.4 d versus 3.5 d, P = 0.030). In terms of oncological outcomes, despite higher incidence of multicentricity and larger tumors, the number of central lymph nodes retrieved during unilateral central neck dissection in RT was significantly greater than ET (4.5 ± 2.6 and 3.4 ± 2.5, P < 0.001) whereas the preablation stimulated thyroglobulin was comparable (0.8 ng/mL versus 1.1 ng/mL, P = 0.456). However, follow-up data were relatively scarce. CONCLUSIONS Adding the robot in remote-access thyroidectomy was associated with a significantly lower risk of temporary recurrent laryngeal nerve injury and shorter length of hospital stay. However, despite achieving a comparable level of surgical completeness for low-risk differentiated thyroid carcinoma between RT and ET, this study highlighted the limitations with the current literature and the need for more prospective studies with adequate follow-up.
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Affiliation(s)
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Julian Shun Tsang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Kai Pun Wong
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
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Rabinovics N, Feinmesser R, Aidan P, Hamzany Y, Bachar G. Robot-assisted transaxillary thyroid surgery-feasibility and safety of a novel technique. Rambam Maimonides Med J 2014; 5:e0013. [PMID: 24808951 PMCID: PMC4011478 DOI: 10.5041/rmmj.10147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Developments in technology have led to a rapid progress in robotic endocrine surgery applications. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising approaches. Its main advantages are improved cosmetic outcome, avoiding cervical incisions, thereby increasing patient satisfaction, and improved visualization, arms articulations, and precision, resulting in fewer surgical complications. The main disadvantages are potential new injuries to the brachial plexus, esophagus, and trachea, longer operative time, and increased cost compared to conventional thyroidectomy. In skilled hands, RATS is a safe alternative to conservative thyroidectomy and should be presented to patients with aesthetic concerns. As with any new emerging technique, careful patient selection is crucial, and further evidence must be sought to confirm its indications over time.
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Affiliation(s)
- Naomi Rabinovics
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- To whom correspondence should be addressed. E-mail:
| | - Raphael Feinmesser
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Patrick Aidan
- Department of ENT Head and Neck surgery, The American Hospital, Paris, France
| | - Yaniv Hamzany
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ban EJ, Yoo JY, Kim WW, Son HY, Park S, Lee SH, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 2014; 28:2555-63. [DOI: 10.1007/s00464-014-3502-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
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50
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Lee HS, Kim D, Lee SY, Byeon HK, Kim WS, Hong HJ, Koh YW, Choi EC. Robot-assisted versus endoscopic submandibular gland resection via retroauricular approach: a prospective nonrandomized study. Br J Oral Maxillofac Surg 2014; 52:179-84. [DOI: 10.1016/j.bjoms.2013.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/02/2013] [Indexed: 01/04/2023]
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