Robot-Assisted Thyroidectomy Versus Open Thyroidectomy in the Treatment of Well Differentiated Thyroid Carcinoma

The evolution and clinical impact of single-port transaxillary robotic thyroidectomy: a comprehensive review

Single-port (SP) transaxillary robotic thyroidectomy represents a significant innovation in the field of endocrine surgery, offering a minimally invasive approach that combines oncological efficacy with enhanced cosmetic outcomes. The introduction of the SP robotic system has enabled surgeons to perform thyroidectomy and lateral neck dissection through a single axillary incision, resulting in a scarless neck and reduced postoperative morbidity. This review explores the current practices and surgical techniques associated with SP transaxillary robotic thyroidectomy, emphasizing the benefits of the SP robotic system over traditional multi-port and open approaches. The system's enhanced precision, due to its articulated instruments and high-definition three-dimensional visualization, allows for meticulous dissection, minimizing the risk of complications such as recurrent laryngeal nerve injury and hypocalcemia. The SP design simplifies the surgical process, reducing trauma to surrounding tissues and leading to faster recovery times and improved patient satisfaction. Clinical outcomes of the SP approach are promising, with studies indicating comparable oncological safety to conventional methods and superior cosmetic results. Patient satisfaction is notably high, particularly regarding the absence of visible neck scarring. However, the technique's adoption is limited by its steep learning curve and the high cost of the SP robotic system. This review also highlights the need for further long-term studies to fully assess the sustainability of the SP robotic system's benefits, especially in terms of oncological outcomes and cost-effectiveness. The potential of the SP transaxillary approach to become a standard option in thyroid surgery is discussed, alongside the importance of continued research and surgeon training to optimize its use. In conclusion, SP transaxillary robotic thyroidectomy offers a compelling alternative to traditional approaches, with the potential to significantly enhance patient outcomes and satisfaction in thyroid surgery.

Exploring exosomes: novel diagnostic and therapeutic frontiers in thyroid cancer

In recent years, the incidence of thyroid cancer has surged globally, posing significant challenges in its diagnosis, treatment, and prognosis. Exosomes, as a class of extracellular vesicles, are secreted by nearly all cell types and encapsulate a variety of nucleic acids and proteins reflective of their cell of origin, thereby facilitating critical intercellular communication. Recent advancements in understanding these exosomes have catalyzed their application in oncology, particularly through uncovering their roles in the pathogenesis, diagnosis, and therapy of cancers. Notably, the latest literature highlights the integral role of exosomes in refining diagnostic techniques, enhancing targeted therapies, optimizing radiotherapy outcomes, and advancing immunotherapeutic approaches in thyroid cancer management. This review provides a current synthesis of the implications of exosomes in thyroid cancer tumorigenesis and progression, as well as their emerging applications in diagnosis and treatment strategies. Furthermore, we discuss the profound clinical potential of exosome-based interventions in managing thyroid cancer, serving as a foundational reference for future therapeutic developments.

A Systematic Review of Current Practices, Challenges, and Future Directions for the Use of Robotic Surgery in Otolaryngology in Greece

Robotic surgery is increasingly used in otolaryngology (ENT), particularly for complex head and neck procedures. It offers various advantages, including limited postoperative pain, excellent aesthetic results, better visualization in the surgical field, enhanced dexterity due to movement adjustment by the robotic system, and minimal complications and hospital stay. However, robotic systems' higher cost and limited availability are a burden for clinical applications. This systematic review is a detailed assessment that looks at the existing situation, problems, and prospects for robotic ENT surgery in Greece. It is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The included studies were chosen based on specific criteria after a thorough inspection of electronic databases of clinical trials and medical journals (PubMed, Scopus, Web of Science). Despite steady adoption, Greece needs to catch up with other European countries in deploying robotic surgery technology. Various possible reasons may cause the small number of ENT robotic-assisted surgeries, including the high cost and the availability of robotic systems, mainly in large private or public hospitals in the main cities of Greece (Athens and Thessaloniki). Training on robotic systems is also very limited for surgery residents and young surgeons, while the learning curve of robotic-assisted surgeries in ENT is big. Peer-reviewed literature was analyzed to compare it with other European nations and investigate the economic, training, and geographic aspects that may be a burden for the rise of robotic surgery in Greece. Through the review scope, this study also provided recommendations concerning the implementation of robotic surgery in daily practice among surgeons in Greece and the difficulties that may arise regarding robotic surgery training in resource-limited countries.

Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes

Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20 years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.

Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications

PURPOSE

Gasless robot-assisted transaxillary hemithyroidectomy (RATH) is regarded as an alternative surgical option for thyroid operations. However, the associated steep learning curve is a clinical concern. This study evaluated the learning curve of RATH for surgeons without experience of endoscopic surgery and the early surgical outcomes of RATH.

METHODS

We conducted a retrospective study of patients who underwent gasless RATH and conventional hemithyroidectomy (CH) at Sun Yat-sen University Cancer Center, Guangzhou, China, from June 2021 to August 2022. The learning curve and early surgical outcomes of gasless RATH were evaluated. And the early surgical outcomes of gasless RATH were compared to CH.

RESULTS

In total, 105 patients who underwent gasless RATH and 104 patients who underwent CH were matched and assessed. The cumulative sum techniques (CUSUM) analysis showed that the peak point of gasless RATH operative time occurred at the 31st case. No clear single peak was identified in the CUSUM plot for drainage amount and blood loss. No significant difference in perioperative complications was observed between these two groups. Moreover, the number of postoperative patients who got sense of thyroid area traction were fewer in the gasless RATH group (n = 11, 10.5%) than in the CH group (n = 32, 30.8%).

CONCLUSION

Gasless RATH can be considered as an alternative approach to the conventional open procedure, as it is an easy remote access technique, with shorter learning curves and certain advantage such as less sense of thyroid area traction.

Optimizing robotic thyroid surgery: lessons learned from an retrospective analysis of 104 cases

Background

Robotic assistance in thyroidectomy is a developing field that promises enhanced surgical precision and improved patient outcomes. This study investigates the impact of the da Vinci Surgical System on operative efficiency, learning curve, and postoperative outcomes in thyroid surgery.

Methods

We conducted a retrospective cohort study of 104 patients who underwent robotic thyroidectomy between March 2018 and January 2022. We evaluated the learning curve using the Cumulative Sum (CUSUM) analysis and analyzed operative times, complication rates, and postoperative recovery metrics.

Results

The cohort had a mean age of 36 years, predominantly female (68.3%). The average body mass index (BMI) was within the normal range. A significant reduction in operative times was observed as the series progressed, with no permanent hypoparathyroidism or recurrent laryngeal nerve injuries reported. The learning curve plateaued after the 37th case. Postoperative recovery was consistent, with no significant difference in hospital stay duration. Complications were minimal, with a noted decrease in transient vocal cord palsy as experience with the robotic system increased.

Conclusion

Robotic thyroidectomy using the da Vinci system has demonstrated a significant improvement in operative efficiency without compromising safety. The learning curve is steep but manageable, and once overcome, it leads to improved surgical outcomes and high patient satisfaction. Further research with larger datasets and longer follow-up is necessary to establish the long-term benefits of robotic thyroidectomy.

Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery

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.

Evaluation of voice function after BABA robotic thyroid lobectomy: A comparative analysis with endoscopic thyroid lobectomy

The purpose of this study was to compare the effect of robotic thyroid lobectomy via Bilateral Axlio-Breast Approach (BABA) and endoscopic thyroid lobectomy on the voice function. A total of 125 patients with thyroid cancer from March 2021 to July 2022 were divided into the robotic thyroid lobectomy group and the endoscopic thyroid lobectomy group. Acoustic index and voice handicap index (VHI-10) were compared between the 2 groups before and after (1 week, 1 month, 3 month) the surgery. In the robotic group, VHI-10 score was not significantly different before and after the surgery. In the endoscopic group, VHI-10 score after the surgery was significantly higher than that before the surgery. In the endoscopic group, the fundamental frequency (F0) declined significantly 1 week and 1 month after the surgery compared with that before the surgery. One week after surgery, F0 in the endoscopic group was (197.91 ± 24.15) Hz, which was significantly lower than that (206.77 ± 20.13) Hz in the robotic group. In the robotic group, there was no obvious decline in F0 and MPT in each follow-up period after surgery compared with those before surgery. In the endoscopic group, MPT declined significantly 1 week after the surgery compared with that before surgery. One week after surgery, MPT in the endoscopic group was (13.02 ± 9.28) s, which was significantly lower than that (17.55 ± 9.25) s in the robotic groups. There were no significant differences in Shimmer, Jitter, DSI and NHR during all postoperative follow-up periods compared with those before surgery in both groups. The voice function of robotic thyroid lobectomy via BABA is superior to endoscopic thyroid lobectomy.

The Advantages of Robotic Over Open Thyroidectomy in Thyroid Diseases: A Systematic Review

Over a hundred thousand thyroid surgeries are performed per year in the United States. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Furthermore, these techniques are new and still debatable. The purpose is to know the advantages of robotic over open thyroidectomy in thyroid diseases. Note that we didn't aim to compare different robotic techniques due to the lack of data.

We performed a systematic review comparing surgical approaches for thyroidectomy, open vs robotic techniques, from January 2017 to December 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. All papers with no full free article access and not in the English language were excluded. The outcomes of interest were superior cosmetics outcome, cost-effectiveness, limitations, operation time, length of hospital stay and postoperative pain or complications, and future outcomes.

A literature search was carried out in electronic databases (PubMed, Google Scholar) in order to retrieve all papers comparing the effectiveness of robotic vs open thyroidectomy. An initial reference search yielded 433 articles. Finally, we chose nine studies covering different robotic thyroidectomy techniques compared to the open thyroidectomy approach. Promising results were seen in these studies, especially with superior cosmetic results, less post-operative pain, swallowing discomfort, and voice changes. In addition, the risk of recurrent laryngeal nerve injury is almost the same as the open approach. Multiple types of biases were caused by the selection of the population and the limitation of the studies to certain regions associated with the low numbers of robotic thyroidectomy approaches in Europe and the United States of America and the lack of randomized trials and long-term follow-up respectively. All studies discussed the importance of the surgeon's skills and the patient decision in choosing the appropriate approach for the thyroidectomy depending on the risk factors, a larger number of patients, and longer follow-up from multiple hospitals.

Learning curve for robotic thyroidectomy using BABA: CUSUM analysis of a single surgeon's experience

BACKGROUND

This study assessed the safety and oncologic outcomes of robotic thyroidectomy via the bilateral axillary breast approach (BABA RT) for conventional open procedures. The learning curves of BABA RT were further evaluated.

METHODS

An exact 1:1 matching analysis was performed to compare the technical safety and oncologic outcomes between robotic thyroidectomy and conventional open surgery. Learning curves were assessed using cumulative summation analysis.

RESULTS

There was no significant difference in general characteristics, short time outcomes (including transient hypoparathyroidism, transient postoperative hoarseness, hematoma/seroma, mean postoperative hospital stay, and other complications), the number of retrieved central lymph nodes, and recurrence rates between robotic BABA and conventional groups. The mean number of retrieved lateral LNs in the robotic group was significantly less than those in the conventional group. The learning curve for working space making, robotic lobectomy, and total thyroidectomy are approximately 15, 30, and 20 cases, respectively. No differences except for operation time were found between the learning group and the proficient group.

CONCLUSIONS

Robotic thyroidectomy and neck dissection via BABA are feasible in terms of surgical completeness, surgical safety, and oncological safety. Our results provide a criterion for judging whether the surgeon has entered the stable stage of robotic thyroidectomy via BABA in terms of the operative time.