Abstract
Background
The transaxillary robot-assisted technique constitutes an acceptable treatment option for patients requiring thyroidectomy. However, patients’ attitudes toward this new technique have not yet been analyzed.
Methods
A sample of 596 randomly selected patients who underwent thyroidectomy between January 2000 and March 2010 was assessed. We evaluated patients’ attitudes toward transaxillary robot-assisted thyroidectomy, taking into account the validated Patient Scar Assessment Questionnaire, the SF-36 Health Survey Questionnaire, and 11 sociodemographic and surgical patient characteristics.
Results
Only 11.6 % of the patients would prefer to have been treated with the transaxillary method. Most patients had concerns that it would be a more painful procedure (39.2 %), and they expressed satisfaction with the existing esthetic outcome (29.1 %); other concerns were that the robotic approach would be of longer duration (25.4 %) and at higher cost (15.5 %). Nevertheless, the worse the appearance of the neck scar the more preferable is the new method (p = 0.025), a result that holds true irrespective of patients’ physical health, the invasive procedure attained (conventional or minimal), and the presence of postoperative complications, among other characteristics. Patients diagnosed with a benign or uncertain neoplasm (p = 0.022) and younger patients (p = 0.003) held a more positive view of the new method.
Conclusions
Patients who have undergone conventional thyroidectomy via the usual neck incision do not express a preference for the transaxillary method. The reasons given include various perceived disadvantages of the robotic procedure (increased pain, longer operative times, and higher cost). Younger patients, patients with poor appearance of their neck scar, and patients with benign thyroid pathology seem to hold a more positive attitude toward the robotic approach.
Similar content being viewed by others
References
Kang SW, Jeong JJ, Nam KH et al (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7
Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406
Kang SW, Lee SC, Lee SH et al (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055
Seybt M, Kuppersmith RB, Holsinger FC et al (2010) Robotic axillary thyroidectomy: multi-institutional clinical experience with the daVinci. Laryngoscope 120(Suppl 4):S182
Foley CS, Agcaoglu O, Siperstein AE et al (2012) Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc 26:2259–2266
Kandil E, Noureldine S, Abdel Khalek M et al (2011) Initial experience using robot-assisted transaxillary thyroidectomy for Graves’ disease. J Visc Surg 148:e447–e451
Kang SW, Park JH, Jeong JS et al (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech 21:223–229
Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526
Lee J, Lee JH, Nah KY et al (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446
Brunaud L, Germain A, Zarnegar R et al (2010) Robotic thyroid surgery using a gasless transaxillary approach: cosmetic improvement or improved quality of surgical dissection? J Visc Surg 147:e399–e402
Lang BH, Chow MP (2011) A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience. Surg Endosc 25:1617–1623
Landry CS, Grubbs EG, Morris GS et al (2011) Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149:549–555
Duncan TD, Rashid Q, Speights F et al (2009) Transaxillary endoscopic thyroidectomy: an alternative to traditional open thyroidectomy. J Natl Med Assoc 101:783–787
Kang SW, Lee SH, Ryu HR et al (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148:1214–1221
Lee J, Yun JH, Nam KH et al (2011) The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol 18:226–232
Holsinger FC, Terris DJ, Kuppersmith RB (2010) Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation. Otolaryngol Clin North Am 43:381–388
Perrier ND, Randolph GW, Inabnet WB et al (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332
Linos D, Economopoulos KP, Kiriakopoulos A et al (2012) Scar perceptions after thyroid and parathyroid surgery: comparison of minimal and conventional approaches. Surgery 153:400–407
Economopoulos KP, Petralias A, Linos E et al (2012) Psychometric evaluation of patient scar assessment questionnaire following thyroid and parathyroid surgery. Thyroid 22:145–150
Linos A, Kiriakopoulos A, Poulios E (2010) Scarless neck by conducting robot-assisted thyroidectomy: our initial experience. Endocr Abstr 22:832
Linos D (2011) Minimally invasive thyroidectomy: a comprehensive appraisal of existing techniques. Surgery 150:17–24
Henry JF (2008) Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 393:621–626
Linos D (2009) Minimally invasive thyroid surgery. In: Frezza EE, Gagner M, Li M (eds) International principles of laparoscopic surgery, 1st edn. Ciné-Med Inc, Woodbury, CT, pp 531–537
Linos D (2012) Minimally invasive non endoscopic thyroidectomy: the MINET approach. In: Linos D, Chung WY (eds) Minimally invasive thyroidectomy, 1st edn. Springer, Heidelberg
Miccoli P, Berti P, Conte M et al (1999) Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest 22:849–851
Seybt MW, Terris DJ (2010) Minimally invasive thyroid and parathyroid surgery: where are we now and where are we going? Otolaryngol Clin North Am 43:375–380
Durani P, McGrouther DA, Ferguson MW (2009) The Patient Scar Assessment Questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg 123:1481–1489
Ware JE Jr, Gandek B (1998) Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 51:903–912
Ware JE Jr, Kosinski M, Gandek B et al (1998) The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International quality of life assessment. J Clin Epidemiol 51:1159–1165
Ware JE Jr, Snow KK, Kosinski M et al. (1993) SF-36 Health Survey Manual and Interpretation Guide, Boston, Massachusetts, The Health Institute, New England Medical Center
Landry CS, Grubbs EG, Warneke CL et al (2012) Robot-assisted transaxillary thyroid surgery in the United States: is it comparable to open thyroid lobectomy? Ann Surg Oncol 19:1269–1274
Kiriakopoulos A, Linos D (2012) Gasless transaxillary robotic versus endoscopic thyroidectomy: exploring the frontiers of scarless thyroidectomy through a preliminary comparison study. Surg Endosc 26:2797–2801
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Linos, D., Kiriakopoulos, A. & Petralias, A. Patient Attitudes toward Transaxillary Robot-assisted Thyroidectomy. World J Surg 37, 1959–1965 (2013). https://doi.org/10.1007/s00268-013-2090-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2090-x