Abstract
Purpose of Review
The purpose of this study was to evaluate the characteristics of patients who underwent transoral robotic thyroidectomy (TORT) in the worldwide literature, especially in comparative studies with transoral endoscopic thyroidectomy by vestibular approach (TOETVA), to better define the ideal appropriate patient.
Recent Findings
TORT allows a more precise and complete dissection due to the enlarged and three-dimensional surgical vision and the tremor filtering. Current inclusion criteria for TORT mainly concern ultrasonographically estimated nodules as having a maximum diameter ≤ 70 mm, the papillary thyroid carcinoma with minimal extrathyroidal extension (T1 to T3) with or without evidence of central lymph node metastasis, and Graves’ disease with an estimated volume ≤ 50 mL. Overall, although TORT requires a longer operating time than TOETVA, it allows for more complex surgical procedures, obtaining better oncological results. A clear definition of the inclusion and exclusion criteria for patients to undergo robotic surgery is essential to obtain the most reliable results in future large comparative and non-comparative studies.
Summary
The purpose of this review article is to analyze both the main comparative studies between TORT and TOETVA series and those involving cohorts of patients operated by TORT, always paying attention to the inclusion and exclusion criteria adopted.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Kim WW, Lee J, Jung JH, Park HY, Tufano RP, Kim HY. A comparison study of the transoral and bilateral axillo-breast approaches in robotic thyroidectomy. J Surg Oncol. 2018;118(3):381–7. https://doi.org/10.1002/jso.25175.
Razavi CR, Vasiliou E, Tufano RP, Russell JO. Learning curve for transoral endoscopic thyroid lobectomy. Otolaryngol Head Neck Surg. 2018;159(4):625–9. https://doi.org/10.1177/0194599818795881.
You JY, Kim H, Park DW, Yang HW, Dionigi G, Tufano RP. Prevention of transoral thyroidectomy complications: an analysis of surgical outcomes in 423 consecutive series. Surgery. 2021;170(4):1155–9. https://doi.org/10.1016/j.surg.2021.05.003.
Ji YB, Ko SH, Song CM, Sung ES, Lee BJ, Wu CW, Chiang FY, Tae K. Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy. Oral Oncol. 2020;103: 104617. https://doi.org/10.1016/j.oraloncology.2020.104617.
Sun H, Dionigi G. Applicability of transoral robotic thyroidectomy: Is it the final solution? J Surg Oncol. 2019;119(4):541–2. https://doi.org/10.1002/jso.25362.
Dionigi G, Tufano RP, Russell J, Kim HY, Piantanida E, Anuwong A. Transoral thyroidectomy: advantages and limitations. J Endocrinol Invest. 2017;40(11):1259–63. https://doi.org/10.1007/s40618-017-0676-0.
Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg. 2018;153(1):21–7.
Richmon JD, Pattani KM, Benhidjeb T, Tufano RP. Transoral robotic-assisted thyroidectomy: a preclinical feasibility study in 2 cadavers. Head Neck. 2011;33(3):330–3.
• Kahramangil B, Mohsin K, Alzahrani H, Bu Ali D, Tausif S, Kang SW, Kandil E, Berber E. Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model. Gland Surg. 2017;6(6):611–9. https://doi.org/10.21037/gs.2017.10.03. An important study describing both techniques, i.e., robotic and endoscopic.
Russell JO, Noureldine SI, Al Khadem MG, Chaudhary HA, Day AT, Kim HY, Tufano RP, Richmon JD. Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform. J Robot Surg. 2017;11(3):341–6. https://doi.org/10.1007/s11701-016-0661-1.
Clark JH, Kim HY, Richmon JD. Transoral robotic thyroid surgery. Gland Surg. 2015;4(5):429–34. https://doi.org/10.3978/j.issn.2227-684X.2015.02.02.
Witzel K, von Rahden BH, Kaminski C, Stein HJ. Transoral access for endoscopic thyroid resection. Surg Endosc. 2008;22(8):1871–5. https://doi.org/10.1007/s00464-007-9734-6.
Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg. 2011;35(3):543–51.
Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016;40(3):491–7. https://doi.org/10.1007/s00268-015-3320-1.
Dionigi G, Lavazza M, Bacuzzi A, Inversini D, Pappalardo V, Tufano RP, Kim HY, Anuwong A. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): from A to Z. Surg Technol Int. 2017;30:103–12.
Tae K, Lee DW, Song CM, Ji YB, Park JH, Kim DS, Tufano RP. Early experience of transoral thyroidectomy: comparison of robotic and endoscopic procedures. Head Neck. 2019;41(3):730–8. https://doi.org/10.1002/hed.25426.
Razavi CR, Khadem MGA, Fondong A, Clark JH, Richmon JD, Tufano RP, Russell JO. Early outcomes in transoral vestibular thyroidectomy: robotic versus endoscopic techniques. Head Neck. 2018;40(10):2246–53. https://doi.org/10.1002/hed.25323.
• Chen YH, Kim HY, Anuwong A, Huang TS, Duh QY. Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes. Surg Endosc. 2021;35(11):6179–89. https://doi.org/10.1007/s00464-020-08114-1. This is the largest comparative study between cohorts of patients operated on with transoral robotic thyroidectomy and endoscopic transoral thyroidectomy with a vestibular approach.
• Park D, Kim HY, Kim HK, You JY, Dionigi G, Russell JO, Tufano RP. Institutional experience of 200 consecutive papillary thyroid carcinoma patients in transoral robotic thyroidectomy surgeries. Head Neck. 2020;42(8):2106–14. https://doi.org/10.1002/hed.26149. This is the study with the largest series of patients operated on for papillary thyroid cancer by transoral robotic thyroidectomy surgery.
Tae K, Ji YB, Song CM, Park JS, Park JH, Kim DS. Safety and efficacy of transoral robotic and endoscopic thyroidectomy: the first 100 cases. Head Neck. 2020;42(2):321–9. https://doi.org/10.1002/hed.25999.
Chae S, Min SY, Park WS. Comparison study of robotic thyroidectomies through a bilateral axillo-breast approach and a transoral approach. J Laparoendosc Adv Surg Tech A. 2020;30(2):175–82. https://doi.org/10.1089/lap.2019.0585.
Kim HK, Kim HY, Chai YJ, Dionigi G, Berber E, Tufano RP. Transoral robotic thyroidectomy: comparison of surgical outcomes between the da Vinci Xi and Si. Surg Laparosc Endosc Percutan Tech. 2018;28(6):404–9. https://doi.org/10.1097/SLE.0000000000000587.
Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD. Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc. 2018;32(2):688–94. https://doi.org/10.1007/s00464-017-5724-5.
Kim HK, Chai YJ, Dionigi G, Berber E, Tufano RP, Kim HY. Transoral robotic thyroidectomy for papillary thyroid carcinoma: perioperative outcomes of 100 consecutive patients. World J Surg. 2019;43(4):1038–46. https://doi.org/10.1007/s00268-018-04877-w.
Shan L, Liu J. A systemic review of transoral thyroidectomy. Surg Laparosc Endosc Percutan Tech. 2018;28(3):135–8.
Camenzuli C, SchembriWismayer P, CallejaAgius J. Transoral endoscopic thyroidectomy: a systematic review of the practice so far. JSLS. 2018;22(3):e2018.00026.
Chen S, Zhao M, Qiu J. Transoral vestibule approach for thyroid disease: a systematic review. Eur Arch Otorhinolaryngol. 2019;276(2):297–304.
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Conceptualization, HYK, GD; Formal analysis: DP, HYK, GD, FaFa; Data curation: AP, FrFr, VV, AM, GD, FaFa; Methodology: HYK, CWW, GD; Writing—original draft preparation, DP, HYK, GD, FaFa; Writing—review and editing, DP, HYK, AP, FrFr, VV, AM, CWW, GD, FaFa; All authors have read and agreed to the published version of the manuscript.
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Park, D., Kim, H.Y., Pino, A. et al. Robotic Versus Endoscopic Transoral Thyroidectomy with Vestibular Approach: A Literature Review Focusing on Differential Patient Suitability. Curr Surg Rep 10, 133–139 (2022). https://doi.org/10.1007/s40137-022-00321-0
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DOI: https://doi.org/10.1007/s40137-022-00321-0