Abstract
Background
Robot-assisted thyroidectomy has been associated with lengthy operative times due to fussy robot preparation and docking maneuvers. The authors propose an endoscopic transaxillary approach using a novel platform, comparing its results with those of the former approach.
Methods
Eight patients (6 females and 2 males; mean age, 38.8 years) with a favorable body habitus (mean body mass index [BMI], 23.4 kg/m2) underwent robot-assisted thyroidectomy through a gasless transaxillary approach using the da Vinci S system. Another four female patients (mean age, 31 years) underwent an endoscopic procedure. The patients’ demographic data, operative time, complications, hospital stay, postoperative visual analog pain score (VAPS), and costs were compared.
Results
Three lobectomies, two near-total thyroidectomies, two total thyroidectomies, and one total thyroidectomy with lateral lymph node dissection were performed in the robotic group. Two lobectomies and two near total thyroidectomies were performed in the endoscopic group. The mean diameter of the largest nodule in the robotic series was 26.5 mm compared with 42.5 mm in the endoscopic group. The mean total operative time was 211 min for the robotic series compared with 160 min for the endoscopic series. There was one temporary recurrent laryngeal nerve paralysis in the robotic group. Two patients in the robotic group exhibited transient symptomatic hypocalcemia compared with one patient in the endoscopic group. Hypoesthesia in the flap dissection area was experienced by three patients in the robotic group and two patients of the endoscopic group. The mean hospital stay was 1.5 days (range 1–3 days) in both groups. The postoperative VAPS also was similar in the two groups (3.1 vs 2.8). The cost was significantly less for the endoscopic approach.
Conclusions
The preliminary comparison in this study shows that both approaches are safe and feasible, with similar results. They also afford an excellent view of the critical neck anatomy that allows precise tissue handling and dissection. However, the endoscopic approach results in a significantly faster and more convenient thyroidectomy.
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References
Linos D (2011) Minimally invasive thyroidectomy: a comprehensive appraisal of existing techniques. Surgery 150:17–223
Slotema ET, Sebag F, Henry JF (2008) What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg 32:1325–1332
Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357
Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231
Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using transaxillary approach: surgical outcome of 581 patients. Endocr J 56:361–369
Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic-assisted endoscopic thyroidectomy for thyroid malignancy using a gasless transaxillary approach. J Am Coll Surg 209:1–7
Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406
Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech 21:223–229
Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE, Perrier ND (2011) Robot-assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149:549–555
Berber E, Siperstein A (2011) Robotic transaxillary total thyroidectomy using a unilateral approach. Surg Laparosc Endosc Percutan Tech 21:207–210
Linos D, Kiriakopoulos A, Poulios E (2010) Scarless neck by conducting robot-assisted thyroidectomy: our initial experience. Endocrine Abstracts 95:20–24
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
Yoo H, Chae BJ, Park HS, Kim KH, Kim SH, Song BJ, Jung SS, Bae JS (2011) Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol doi:10.1002/jso.22106
Lee J, Lee JH, Nah KY, Soh EY, Chung WY (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446
Disclosure
Andreas Kiriakopoulos and Dimitrios Linos no conflicts of interest or financial ties to disclose.
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Kiriakopoulos, A., Linos, D. Gasless transaxillary robotic versus endoscopic thyroidectomy: exploring the frontiers of scarless thyroidectomy through a preliminary comparison study. Surg Endosc 26, 2797–2801 (2012). https://doi.org/10.1007/s00464-012-2281-9
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DOI: https://doi.org/10.1007/s00464-012-2281-9