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Bilateral axillo-breast approach robotic thyroidectomy (BABA-RT) versus transoral robotic thyroidectomy (TORT): a systematic review and meta-analysis

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Abstract

The aim of this study is to conduct a systematic review and meta-analysis of all comparative studies that evaluated the surgical outcomes between bilateral axillo-breast approach-robotic thyroidectomy (BABA-RT) and transoral robotic thyroidectomy (TORT). The Cochrane Central Register of Controlled Trials, PubMed, Scopus, and Web of Science databases were screened until July 2022. The Risk of Bias in Non-Randomized Studies for Interventions (ROBINS-I) tool was used to evaluate study quality. The data were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a fixed-effects or random-effects model. Five comparative observational studies met the inclusion criteria comprising 923 patients (TORT = 408 and BABA-RT = 515). The study quality varied and included low (n = 4) and moderate (n = 1) risk of bias. There was no significant difference between both groups regarding the mean operative time (MD = 19.98 min, 95% CI [−11.33, 51.28], p = 0.21), mean hospital stay (MD = −0.14 days, 95% CI [−0.66, 0.38], p = 0.60), mean number of retrieved lymph nodes (MD = 0.42, 95% CI [−0.16, 0.99], p = 0.16), and rate of recurrent laryngeal nerve injury (RR = 0.39, 95% CI [0.13, 1.19], p = 0.10). However, the TORT group had significantly reduced mean postoperative pain score (MD = −0.39, 95% CI [−0.51, −0.26], p < 0.001) and lower rate of hypocalcemia (RR = 0.08, 95% CI [0.02, 0.26], p < 0.001) than the BABA-RT group. TORT and BABA-RT have comparable surgical outcomes. Both methods are largely safe and effective when patients are carefully chosen. However, TORT appears to offer better results regarding postoperative pain and hypocalcemia. Further clinical trials with extended follow-up periods are needed to confirm our findings.

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All data are available within the manuscript and its supplemental files.

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Authors and Affiliations

  1. Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait

    Ebraheem Albazee, Reham Alabdulhadi, Danah Ibrahim Alkandari, Sara Sulaiman & Jasem Ameen

  2. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Ahmed Abdelaziz

  3. College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain

    Aysha Abduljabbar

  4. Faculty of Medicine, The Hashemite University, Zarqa, Jordan

    Mohammad Alnifise

  5. Touro College of Osteopathic Medicine, Harlem, NY, USA

    Houda Magzoub

  6. College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada

    Karim Alomar

  7. Department of Surgery, King Fahad Central Hospital, Jazan, Saudi Arabia

    Shaima Ali Maghdi

  8. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Ahmed Abu-Zaid

  9. College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Ahmed Abu-Zaid

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  1. Ebraheem Albazee
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Contributions

EA and AAZ contributed to study conception, data analysis, study supervision, and manuscript writing. AA, RA, DIA, AA, SS, MA, JA, HM, KA, and SAM contributed to literature review, data collection, data interpretation, and revision of manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript.

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Correspondence to Ahmed Abu-Zaid.

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Albazee, E., Abdelaziz, A., Alabdulhadi, R. et al. Bilateral axillo-breast approach robotic thyroidectomy (BABA-RT) versus transoral robotic thyroidectomy (TORT): a systematic review and meta-analysis. Updates Surg 75, 1277–1287 (2023). https://doi.org/10.1007/s13304-023-01539-y

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