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Park J, Kim K. Current and Future of Robotic Surgery in Thyroid Cancer Treatment. Cancers (Basel) 2024; 16:2470. [PMID: 39001532 PMCID: PMC11240454 DOI: 10.3390/cancers16132470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
Thyroid cancer is among the most common endocrine malignancies, necessitating effective surgical interventions. Traditional open cervicotomy has long been the standard approach for thyroidectomy. However, the advent of robotic surgery has introduced new possibilities for minimally invasive procedures with benefits in terms of cosmetic outcomes, enhanced precision, comparable complication rates, and reduced recovery time. This study mainly reviewed the most widely used and well-known robotic thyroidectomy approaches: the transaxillary approach, the bilateral axillo-breast approach, and the transoral approach. This review examines the current status and future potential of robotic surgery in thyroid cancer treatment, comparing its efficacy, safety, and outcomes with those of conventional open cervicotomy. Challenges such as a longer operative time and higher costs exist. Future directions include technological advancements, tele-surgery, single-port surgery, and the integration of artificial intelligence. Robotic surgery holds promise in optimizing patient outcomes in thyroid cancer treatment.
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Affiliation(s)
- Joonseon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Kang YJ, Stybayeva G, Hwang SH. Surgical safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy: a systematic review and meta-analysis. Braz J Otorhinolaryngol 2024; 90:101376. [PMID: 38228051 PMCID: PMC10823096 DOI: 10.1016/j.bjorl.2023.101376] [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: 09/23/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor. METHODS Bilateral axillo-breast approach robotic thyroidectomy and other approaches (open thyroidectomy, transoral robotic thyroidectomy, and bilateral axillo-breast approach endoscopic thyroidectomy) were compared in studies from 6 databases. RESULTS Twenty-two studies (8830 individuals) were included. Bilateral axillo-breast approach robotic thyroidectomy had longer operation time, greater cosmetic satisfaction, and reduced transient hypoparathyroidism than conventional open thyroidectomy. Compared to bilateral axillo-breast approach endoscopic thyroidectomy, bilateral axillo-breast approach robotic thyroidectomy had greater amount of drainage, lower chances of transient vocal cord palsy and permanent hypothyroidism, and better surgical completeness (postopertive thyroblobulin level and lymph node removal). Bilateral axillo-breast approach robotic thyroidectomy induced greater postoperative drainage and greater patient dissatisfaction than transoral robotic thyroidectomy. CONCLUSION Bilateral axillo-breast approach robotic thyroidectomy is inferior to transoral robotic thyroidectomy in drainage and cosmetic satisfaction but superior to bilateral axillo-breast approach endoscopic thyroidectomy in surgical performance. Its operation time is longer, but its cosmetic satisfaction is higher than open thyroidectomy.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, United States
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Bucheon St. Mary's Hospital, Seoul, Republic of Korea.
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Yuan Y, Pan B, Tang E, Mo H, Zhu J, Yi Z, Lu D, Yin T, Sun Y, Yin S, Yang Z, Zhang F. Surgical methods of total thyroidectomy for differentiated thyroid cancer: a systematic review and Bayesian network meta-analysis. Int J Surg 2024; 110:529-540. [PMID: 37916941 PMCID: PMC10793844 DOI: 10.1097/js9.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods. METHODS The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome. RESULTS Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92). CONCLUSIONS Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
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Affiliation(s)
- Yuquan Yuan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Bin Pan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Junping Zhu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Dengwei Lu
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Tingjie Yin
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Zeyu Yang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Fan Zhang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
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Zhang R, Chen Y, Deng X, Qiao D, Li X, Yang H. Comparison of bilateral axillo-breast approach robotic thyroidectomy and open thyroidectomy for papillary thyroid carcinoma. J Robot Surg 2023; 17:1933-1942. [PMID: 37358693 DOI: 10.1007/s11701-023-01655-2] [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: 05/03/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
For papillary thyroid carcinoma (PTC) surgery requiring total thyroidectomy and central lymph node dissection, it is controversial whether the bilateral axillo-breast approach robotic thyroidectomy (BABA RT) can replace the open thyroidectomy (OT). To evaluate the efficacy of two surgical approaches. Relevant literatures were searched from PubMed, EMBASE and Cochrane Library. Studies comparing two surgical approaches and meeting the inclusion criteria were selected. Compared with OT, BABA RT showed a similar incidence of postoperative complications, including recurrent laryngeal nerve palsy, hypocalcemia, hypoparathyroidism, bleeding, chyle leakage and incision infection, as well as number of retrieved central lymph nodes and postoperative total dose of radioactive iodine. However, BABA RT involved longer operative time (weighted mean difference [WMD] 72.62, 95% confidence interval [CI] 48.15-97.10, P < .00001) and higher postoperative stimulated thyroglobulin level ([WMD] 0.12, 95% [CI] 0.05-0.19, P = .0006). The efficacy of BABA RT is basically similar to OT in this meta-analysis, but the higher postoperative stimulated thyroglobulin level attracts our attention. Longer operative time requires us to shorten. Randomized clinical trials with large samples and longer follow-up data are still essential to further demonstrate the value of the BABA RT.
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Affiliation(s)
- Rongjia Zhang
- Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yulu Chen
- Department of Cardiovascular Medicine, Shifang People's Hospital, Deyang, Sichuan, China
| | - Xian Deng
- Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Dehui Qiao
- Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Xu Li
- Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Hui Yang
- Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Kim DH, Kim SW, Kim GJ, Basurrah MA, Hwang SH. Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta-Analysis. Laryngoscope 2023; 133:2470-2479. [PMID: 36892037 DOI: 10.1002/lary.30645] [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: 10/25/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Minimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta-analysis could not provide comparative data between new techniques. This network meta-analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods. DATA SOURCES The PubMed, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar. REVIEW METHODS The nine interventions included minimally invasive video-assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo-breast-approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro-auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta-analyses were performed. RESULTS EO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding. CONCLUSION It was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 133:2470-2479, 2023.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mohammed A Basurrah
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Papini P, De Palma A, Ginesini M, Rossi L, Fregoli L, Elisei R, Matrone A, Morganti R, Ambrosini CE, Materazzi G. Robot-assisted transaxillary surgery for thyroid cancer: Oncologic and surgical outcomes in long term follow-up. Int J Med Robot 2023:e2563. [PMID: 37642163 DOI: 10.1002/rcs.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The use of robot-assisted transaxillary thyroidectomy (RATT) has rapidly spread in the last 2 decades, although it is mostly limited to Asian countries. METHOD We retrospectively enroled all patients with histologic diagnoses of thyroid cancer who underwent RATT at the University Hospital of Pisa from May 2012 to September 2020. RESULTS The study included 242 patients; 128 (47%) underwent total thyroidectomy and 114 (53%) underwent thyroid lobectomy, among which 28 patients (24.6%) required completion thyroidectomy. Radioactive iodine ablation therapy was required in 90 patients (37%). The complication rate was 5.3%. After a median follow-up of 38 months, an excellent response to therapy was achieved in 107 patients (74%), whereas the response was indeterminate in 12 (8%) and incomplete in 16 (11%). No local or distant relapses or increases in thyroglobulin or antibody levels were documented. CONCLUSIONS In experienced hands, RATT represents a valid option for the treatment of thyroid cancer in selected cases.
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Affiliation(s)
- Piermarco Papini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Andrea De Palma
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Lorenzo Fregoli
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Carlo Enrico Ambrosini
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy
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Kang YJ, Stybayeva G, Hwang SH. Surgical completeness and safety of minimally invasive thyroidectomy in patients with thyroid cancer: A network meta-analysis. Surgery 2023; 173:1381-1390. [PMID: 36973129 DOI: 10.1016/j.surg.2023.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/09/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND To assess the surgical outcomes of various minimally invasive and remote-access surgical approaches for thyroid cancer patients. METHODS We collected studies from January 2020 to July 2022 in 6 databases. Pairwise and network meta-analyses were performed for outcomes and complications of 9 minimally invasive interventions (minimally invasive video-assisted, endoscopic or robotic bilateral axillo-breast approach, endoscopic or robotic postauricular, endoscopic or robot transaxillary approach, transoral endoscopic thyroidectomy vestibular approach or robotic thyroidectomy) and conventional thyroidectomy (control). RESULTS Multiplicity and bilaterality of cancer, lymph node metastasis, and coincidence of thyroiditis showed no significant difference between minimally invasive interventions and control. However, larger tumor size (robotic bilateral axillo-breast approach standardized mean difference -1.3989, 95% confidence interval [-2.1717 to -0.6262]), higher body mass index (robot transaxillary approach standardized mean difference -0.5350, 95% confidence interval [-0.9557 to -0.1144], robotic bilateral axillo-breast approach standardized mean difference -0.2301, 95% confidence interval [-0.4389 to -0.0214]), and frequent extrathyroidal extension (robotic bilateral axillo-breast approach standardized mean difference 0.7435, 95% confidence interval [0.5602-0.9869]) were observed in control. In surgical outcomes and adverse effects, there was no significant difference in hospitalization or retrieved lymph node number between minimally invasive interventions and control. However, longer operative time was observed in the robotic bilateral axillo-breast approach(standardized mean difference 6.5393, 95% confidence interval [5.0476-8.0309]) and transoral robotic thyroidectomy (standardized mean difference 5.4946, 95% confidence interval [2.9984-7.9907]) groups than in control. In surgical completion, the rate of low postoperative serum thyroglobulin, postoperative thyroglobulin level, and postoperative radioactive iodine ablation dose showed no significant difference between minimally invasive interventions and control. CONCLUSION Minimally invasive thyroidectomy did not show inferior results compared to conventional thyroidectomy despite the longer operative time. Surgeons need to prudently consider all aspects of patients to determine the proper surgical approach for thyroid cancer.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Se Hwan Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Paek SH, Kwon H, Kang KH. A Comparison of the Bilateral Axillo-breast Approach (BABA) Robotic and Open Thyroidectomy for Papillary Thyroid Cancer After Propensity Score Matching. Surg Laparosc Endosc Percutan Tech 2022; 32:537-541. [PMID: 36044331 DOI: 10.1097/sle.0000000000001085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND We aimed to investigate the potential advantages of bilateral axillo-breast approach (BABA) robotic thyroidectomy over conventional open surgery and to determine whether it is a safe and complete surgical procedure compared with open surgery in patients with papillary thyroid cancer. PATIENTS AND METHODS We retrospectively reviewed the records of 315 consecutive patients (robotic, n=54; open, n=261) who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer from March 2013 to June 2014. Postoperative complication rate and surgical completeness were analyzed between patients who underwent BABA robotic thyroidectomy (robotic group) and those who chose open thyroidectomy (open group) after propensity score matching according to age, sex, body mass index, tumor size, extrathyroidal extension, and lymph node (LN) metastasis. RESULTS Transient hypoparathyroidism was higher in the open group than in the robotic group (13.0% vs. 1.9%; P =0.029). No difference was observed in the mean number of retrieved LNs and metastatic LNs. The mean level of stimulated thyroglobulin was acceptably low in both groups, and there was no difference in the proportion of patients who had stimulated thyroglobulin levels <1 ng/mL between the groups ( P =0.543). CONCLUSIONS Our results show that the outcomes of BABA robotic thyroidectomy may be comparable to those of conventional open thyroidectomy, with possibly better preservation of blood supply to the parathyroid glands, without sacrificing surgical completeness.
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Affiliation(s)
- Se Hyun Paek
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
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Pavlidis ET, Psarras KK, Symeonidis NG, Martzivanou ECK, Nikolaidou CC, Stavrati KE, Pavlidis TE. Robot-Assisted Thyroidectomy Versus Open Thyroidectomy in the Treatment of Well Differentiated Thyroid Carcinoma. JSLS 2021; 25:JSLS.2021.00032. [PMID: 34354333 PMCID: PMC8325479 DOI: 10.4293/jsls.2021.00032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of thyroid cancer has increased worldwide during the last decade, becoming the most common endocrine malignancy and accounting for 3.8% of new cancer diagnosis. Surgical resection, namely conventional thyroidectomy, remains at the frontline of therapy, as surgical outcomes are undoubtedly successful. Minimally invasive techniques gained popularity through the years, in terms of feasibility, safety, and cosmesis. However, endoscopic approach could be characterized by some limitations concerning thyroid surgery. Robotic technology with its unique features was introduced to overcome these limitations. Since then, robotic thyroidectomy has been used for both benign and malignant thyroid disease. DATABASE This study presents the use of robot-assisted transaxillary thyroidectomy in well-differentiated thyroid carcinoma through an extensive review of the literature in the PubMed database, including previous meta-analyses and case series. CONCLUSION In terms of oncological efficacy, morbidity, and quality of life, outcomes seem comparable in thyroid cancer patients undergoing either open or robotic thyroidectomy. Surgical completeness also appears similar. Moreover, the rates of locoregional recurrence and survival outcome at 5 years are similar between the former and the latter, thus confirming the oncological value of robotic thyroidectomy for differentiated thyroid cancer. In order for more surgeons to adopt robotic approaches several issues need to be resolved, namely: expansion of robotic thyroidectomy in treating larger well-differentiated carcinomas and neck dissection, equipment costs, and prolonged operation times.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kyriakos K Psarras
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Eirini-Chrysovalantou K Martzivanou
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Christina C Nikolaidou
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kalliopi E Stavrati
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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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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Robotic surgery versus open surgery for thyroid neoplasms: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2020; 146:3297-3312. [PMID: 33108513 DOI: 10.1007/s00432-020-03418-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included. RESULTS In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery. CONCLUSIONS Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.
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Kaliszewski K, Wojtczak B, Sutkowski K, Rudnicki J. Thyroid cancer surgery - in what direction are we going? A mini-review. J Int Med Res 2020; 48:300060520914803. [PMID: 32249645 PMCID: PMC7136939 DOI: 10.1177/0300060520914803] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally invasive procedures for treating thyroid disease have been established in recent decades. Total endoscopic and robotic procedures have been slowly and successively introduced while meeting all oncological criteria. Our analysis of the advantages and disadvantages of scarless surgical procedures suggests that the cosmetic aspects of these surgeries will continue to become more important. This review assesses the recent findings regarding the roles of endoscopic and robotic procedures in thyroid cancer surgery.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Paek SH, Lee HA, Kwon H, Kang KH, Park SJ. Comparison of robot-assisted modified radical neck dissection using a bilateral axillary breast approach with a conventional open procedure after propensity score matching. Surg Endosc 2019; 34:622-627. [PMID: 31065778 DOI: 10.1007/s00464-019-06808-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/29/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is ongoing debate about whether or not robot-assisted thyroidectomy is appropriate for modified radical neck dissection (MRND). The purpose of this study was to compare the surgical outcomes of robot-assisted MRND with those of a conventional open procedure. METHODS One hundred and forty-five patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND (robotic, n = 28; open, n = 117) at our institution from June 2011 to June 2015 were enrolled in the study. The surgical completeness and complication rates in the robotic and open groups were retrospectively compared after 1:3 propensity score matching for age, sex, body mass index, tumor size, and extrathyroidal extension. RESULTS The complication rates, including transient or permanent hypoparathyroidism and recurrent laryngeal nerve palsy, were comparable between the study groups (p > 0.05). The operating time was significantly longer in the robotic group than in the open group (p < 0.001). There was no significant difference in the number of retrieved lymph nodes, metastatic lymph nodes, or stimulated serum thyroglobulin level between the two groups (p = 0.733, p = 0.663, and p = 0.285, respectively). CONCLUSIONS The surgical outcomes, including complication and completeness rates, were comparable between robot-assisted MRND using a bilateral axillary breast approach and conventional open surgery. Robot-assisted MRND can be recommended as an alternative to a conventional open procedure for thyroidectomy.
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Affiliation(s)
- Se Hyun Paek
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyungju Kwon
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung Ho Kang
- New Jahra Hospital Project Team, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sung Jun Park
- Department of Surgery, Sung Min Hospital, Incheon, Korea
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