Abstract
Background
Surgical outcomes of patients with thyroid carcinoma who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus transoral robotic thyroidectomy (TORT) were compared.
Methods
Patients who underwent TOETVA or TORT between July 2016 and February 2022 were retrospectively analyzed. TOETVA and TORT groups were propensity score-matched (1:1) based on age, sex, body mass index, surgical extent, tumor size, and presence of thyroiditis.
Results
A total of 185 patients underwent transoral thyroidectomy (142 TOETVA and 43 TORT). Final diagnoses consisted of 135 papillary and seven follicular thyroid carcinomas in the TOETVA group and 43 papillary thyroid carcinomas in the TORT group (p = 0.138). Mean operative time was shorter for the TOETVA group than the TORT group (106.3 vs. 158.9 min, p < 0.001), whereas mean hospital stay was longer for the TOETVA group than the TORT group (2.2 vs. 1.9 days, p = 0.031). After 1:1 propensity score matching, each group included 43 patients. Mean operative time was shorter in the TOETVA group than the TORT group (106.2 vs. 158.9 min, p < 0.001), whereas mean hospital stay was longer in the TOETVA group (2.3 vs. 1.9 days, p = 0.031). There was no significant difference in vocal cord palsy incidences between the groups (one transient, one permanent in the TOETVA group vs. none in the TORT group, p = 0.359). The learning curve was 71 cases for TOETVA and 25 cases for TORT.
Conclusion
TOETVA had shorter mean operative time, and TORT had shorter learning curve and shorter mean hospital stay. Surgeons should be familiar with the advantages and disadvantages of each procedure.
Similar content being viewed by others
References
Chai YJ, Chung JK, Anuwong A, Dionigi G, Kim HY, Hwang KT, Heo SC, Yi KH, Lee KE (2017) Transoral endoscopic thyroidectomy for papillary thyroid microcarcinoma: initial experience of a single surgeon. Ann Surg Treat Res 93:70–75
Anuwong A, Kim HY, Dionigi G (2017) Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg 6:277–284
Lira RB, Ramos AT, Nogueira RMR, de Carvalho GB, Russell JO, Tufano RP, Kowalski LP (2020) Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve. Oral Oncol 110:104871
Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2018) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32:688–694
Dionigi G, Tufano RP, Russell J, Kim HY, Piantanida E, Anuwong A (2017) Transoral thyroidectomy: advantages and limitations. J Endocrinol Invest 40:1259–1263
Tae K, Ji YB, Song CM, Ryu J (2019) Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol 12:1–11
Lee HY, You JY, Woo SU, Son GS, Lee JB, Bae JW, Kim HY (2015) Transoral periosteal thyroidectomy: cadaver to human. Surg Endosc 29:898–904
Chai YJ, Lee KE, Youn YK (2014) Can robotic thyroidectomy be performed safely in thyroid carcinoma patients? Endocrinol Metab (Seoul) 29:226–232
Chai YJ, Kim HY, Kim HK, Jun SH, Dionigi G, Anuwong A, Richmon JD, Tufano RP (2018) Comparative analysis of 2 robotic thyroidectomy procedures: Transoral versus bilateral axillo-breast approach. Head Neck 40:886–892
Kim WW, Lee J, Jung JH, Park HY, Tufano RP, Kim HY (2018) A comparison study of the transoral and bilateral axillo-breast approaches in robotic thyroidectomy. J Surg Oncol 118:381–387
You JY, Kim HY, Chai YJ, Kim HK, Anuwong A, Tufano RP, Dionigi G (2019) Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes in thyroid malignancies. J Laparoendosc Adv Surg Tech A 29:796–800
Randolph GW, Dralle H, International Intraoperative Monitoring Study G, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(1):S1-16
Chai YJ, Chae S, Oh MY, Kwon H, Park WS (2021) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): surgical outcomes and learning curve. J Clin Med 10:863
Chen YH, Kim HY, Anuwong A, Huang TS, Duh QY (2021) Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes. Surg Endosc 35:6179–6189
Akritidou E, Douridas G, Spartalis E, Tsourouflis G, Dimitroulis D, Nikiteas NI (2022) Complications of trans-oral endoscopic thyroidectomy vestibular approach: a systematic review. In Vivo 36:1–12
Kim HK, Chai YJ, Dionigi G, Berber E, Tufano RP, Kim HY (2019) Transoral robotic thyroidectomy for papillary thyroid carcinoma: perioperative outcomes of 100 consecutive patients. World J Surg 43:1038–1046
Lee J-H, Chai YJ (2020) Up-to-date evidences of transoral thyroidectomy on how to overcome the obstacles? A review. Ann Thyroid 5:25
Kim HK, Kim HK, Park D, Kim HY (2019) Robotic transoral thyroidectomy: right thyroidectomy and ipsilateral central neck dissection with da Vinci Si surgical system. J Minim Invasive Surg 22:43–45
Ban EJ, Yoo JY, Kim WW, Son HY, Park S, Lee SH, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2014) Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 28:2555–2563
Zhang D, Sun H, Tufano R, Caruso E, Dionigi G, Kim HY (2020) Recurrent laryngeal nerve management in transoral endoscopic thyroidectomy. Oral Oncol 108:104755
Beninato T, Kleiman DA, Scognamiglio T, Fahey TJ, Zarnegar R (2012) Tract recurrence of a follicular thyroid neoplasm following transaxillary endoscopic thyroidectomy. Thyroid 22:214–217
Chai YJ, Song J, Kang J, Woo JW, Song RY, Kwon H, Kim SJ, Choi JY, Lee KE (2016) A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad. Ann Surg Treat Res 90:239–245
Ha TK, Kim DW, Park HK, Shin GW, Heo YJ, Baek JW, Lee YJ, Choo HJ, Kim DH, Jung SJ, Park JS, Moon SH, Ahn KJ, Baek HJ, Kang T (2018) Comparison of postoperative neck pain and discomfort, swallowing difficulty, and voice change after conventional open, endoscopic, and robotic thyroidectomy: a single-center cohort study. Front Endocrinol (Lausanne) 9:416
Ryu HR, Lee J, Park JH, Kang SW, Jeong JJ, Hong JY, Chung WY (2013) A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: a prospective study. Ann Surg Oncol 20:2279–2284
Lee J, Yun JH, Choi UJ, Kang SW, Jeong JJ, Chung WY (2012) Robotic versus endoscopic thyroidectomy for thyroid cancers: a multi-institutional analysis of early postoperative outcomes and surgical learning curves. J Oncol 2012:734541
Lee J, Lee JH, Nah KY, Soh EY, Chung WY (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Min Jung Lee, Moon Young Oh, Jung-Man Lee, Jiyu Sun, and Young Jun Chai have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lee, M.J., Oh, M.Y., Lee, JM. et al. Comparative surgical outcomes of transoral endoscopic and robotic thyroidectomy for thyroid carcinoma: a propensity score-matched analysis. Surg Endosc 37, 1132–1139 (2023). https://doi.org/10.1007/s00464-022-09636-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09636-6