Multicenter Study of Robotic Thyroidectomy: Short-Term Postoperative Outcomes and Surgeon Ergonomic Considerations
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Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.
Materials and Methods
We reviewed the medical records of 2014 consecutive patients who underwent RT, conducted by 7 surgeons, at 4 centers between October 2007 and June 2010. Patient characteristics, perioperative clinical results, complications, and pathologic outcomes were analyzed. Moreover, surgeons were surveyed to gather data on musculoskeletal discomfort experienced during OT, ET, and RT.
Of the 2014 patients, 740 underwent total and 1274 subtotal thyroidectomy. Mean tumor diameter was 0.8 cm, and the mean number of retrieved central lymph nodes was 4.5 ± 3.9 (range 0–28). The rates of permanent recurrent laryngeal nerve injury and permanent hypocalcemia were 0.4 and 0.05%, respectively. Neck and/or back pain after OT, ET, and RT was experienced by 100, 85.7, and 28.6% of surgeons, respectively. When surgeons ranked the operative approaches in decreasing order of associated pain, 57.1% indicated ET > OT > RT, 28.6% selected OT > ET > RT, and 14.3% responded ET > RT > OT.
RT is a feasible and safe procedure that may facilitate radical cervical lymph node dissection. Moreover, for surgeons, the RT resulted in less musculoskeletal discomfort than did OT or ET. A larger prospective study, with a longer follow-up, is needed to determine whether RT offers real benefits for both patients and surgeons.
- Kang, SW, Jeong, JJ, Yun, JS, Sung, TY, Lee, SC, Lee, YS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 23: pp. 2399-2406 CrossRef
- Kang, SW, Lee, SC, Lee, SH, Lee, KY, Jeong, JJ, Lee, YS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery. 146: pp. 1048-1055 CrossRef
- Kang, SW, Jeong, JJ, Nam, KH, Chang, HS, Chung, WY, Park, CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg. 209: pp. e1-e7 CrossRef
- Lewis, CM, Chung, WY, Holsinger, FC (2010) Feasibility and surgical approach of transaxillary approach robotic thyroidectomy without CO(2) insufflation. Head Neck. 32: pp. 121-126
- Berber, E, Heiden, K, Akyildiz, H, Milas, M, Mitchell, J, Siperstein, A (2010) Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique. Surg Laparosc Endosc Percutan Tech. 20: pp. e60-e63 CrossRef
- Landry CS, Grubbs EG, Stephen Morris G, Turner NS, Christopher Holsinger C, Lee JE, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery. doi:10.1016/j.surg.2010.08.014 [Epub ahead of print].
- Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh EY. Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc. doi:10.1007/s00464-010-1296-3 [Epub ahead of print].
- Lee J, Yun JH, Nam KH, Soh EY Chung WY. The learning curve for robotic thyroidectomy: A multicenter study. Ann Surg Oncol. doi:10.1245/s10434-010-1220-z [Epub ahead of print].
- Lee, J, Nah, KY, Kim, RM, Ahn, YH, Soh, EY, Chung, WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc. 24: pp. 3186-3194 CrossRef
- Tae, K, Ji, YB, Jeong, JH, Lee, SH, Jeong, MA, Park, CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc. 25: pp. 221-228 CrossRef
- Szeto, GP, Ho, P, Ting, AC, Poon, JT, Tsang, RC, Cheng, SW (2010) A study of surgeon’s postural muscle activity during open, laparoscopic, and endovascular surgery. Surg Endosc. 24: pp. 1712-1721 CrossRef
- Berguer, R, Forkey, D, Smith, WD (1999) Ergonomic problems associated laparoscopic instruments. Surg Endosc. 13: pp. 466-468 CrossRef
- Manukyan, GA, Waseda, M, Inaki, N, Torres Bermudez, JR, Gacek, IA, Rudinski, A (2007) Ergonomics with the use of curved versus straight laparoscopic graspers during rectosigmoid resection: results of a multiprofile comparative study. Surg Endosc. 21: pp. 1079-1089 CrossRef
- Bagrodia, A, Raman, JD (2009) Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques. J Endourol. 23: pp. 627-633 CrossRef
- Mirbod, SM, Yoshida, H, Miyamoto, K, Miyashita, K, Inaba, R, Iwata, H (1995) Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health. 67: pp. 179-186
- Albayrak, A, Veelen, MA, Prins, JF, Snijders, CJ, Ridder, H, Kazemier, G (2007) A newly designed ergonomic body support for surgeons. Surg Endosc. 21: pp. 1835-1840 CrossRef
- Pigazzi, A, Luca, F, Patriti, A, Valvo, M, Ceccarelli, G, Casciola, L (2010) Multicenter study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 17: pp. 1614-1620 CrossRef
- Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL, Mandel, SJ (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19: pp. 1167-1214 CrossRef
- Baik, SH, Kwon, HY, Kim, JS, Hur, H, Sohn, SK, Cho, CH (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 16: pp. 1480-1487 CrossRef
- Bhattacharyya, N, Fried, MP (2001) Benchmarks for mortality, morbidity, and length of stay for head and neck surgical procedures. Arch Otolaryngol Head Neck Surg. 127: pp. 127-132
- Chisholm, EJ, Kulinskaya, E, Tolley, NS (2009) Systemic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 119: pp. 1135-1139 CrossRef
- Steinmuller, T, Klupp, J, Wenking, S, Neuhaus, P (1999) Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg. 384: pp. 50-53 CrossRef
- Henry, JF, Gramatica, L, Denizot, A, Kvachenyuk, A, Puccini, M, Defechereux, T (1998) Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 383: pp. 167-169
- 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: pp. 1349-1357 CrossRef
- 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: pp. 1325-1332 CrossRef
- Yoon, JH, Park, CH, Chung, WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech. 16: pp. 226-231 CrossRef
- Ikeda, Y, Takami, H, Sasaki, Y, Takayama, J, Kurihara, H (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy?. World J Surg. 28: pp. 1075-1078 CrossRef
- Wauben, LS, Veelen, MA, Gossot, D, Goossens, RH (2006) Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 20: pp. 1268-1274 CrossRef
- Liberman, AS, Shrier, I, Gordon, PH (2005) Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc. 19: pp. 1606-1609 CrossRef
- Szeto, GP, Ho, P, Ting, AC, Poon, JT, Cheng, SW, Tsang, RC (2009) Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil. 19: pp. 175-184 CrossRef
- Veelen, Ma, Kazemier, G, Koopman, J, Goossens, RH, Meijer, DW (2002) Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech. 12: pp. 47-52 CrossRef
- Matern, U, Kuttler, G, Giebmeyer, C, Waller, P, Faist, M (2004) Ergonomics aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: an electromyographic-based study. Surg Endosc. 18: pp. 1231-1241 CrossRef
- Nguyen, NT, Ho, HS, Smith, WD, Philipps, C, Lewis, C, Vera, RM (2001) An ergonomic evaluation of surgeons’ axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg. 182: pp. 720-724 CrossRef
- Berguer, R, Smith, W (2006) An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res. 134: pp. 87-92 CrossRef
- Multicenter Study of Robotic Thyroidectomy: Short-Term Postoperative Outcomes and Surgeon Ergonomic Considerations
Annals of Surgical Oncology
Volume 18, Issue 9 , pp 2538-2547
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- 1. Department of Surgery, Ajou University School of Medicine, Suwon, Korea
- 2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- 3. Department of Surgery, Won-Kwang University School of Medicine, Iksan, Korea
- 4. Department of Surgery, Ulsan University School of Medicine, Seoul, Korea