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World Journal of Surgery

, Volume 40, Issue 1, pp 110–116 | Cite as

Long-Term Voice Outcomes After Robotic Thyroidectomy

  • Chang Myeon Song
  • Bo Ram Yun
  • Yong Bae Ji
  • Eui Suk Sung
  • Kyung Rae Kim
  • Kyung TaeEmail author
Original Scientific Report

Abstract

Background

The purpose of this study was to evaluate the long-term voice function after robotic thyroidectomy in comparison with conventional transcervical thyroidectomy.

Methods

We prospectively evaluated the voice functions of 54 patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillary or axillo-breast approach and of 70 patients who underwent conventional thyroidectomy. Subjective voice symptom score (VSS) was evaluated in questionnaires before thyroidectomy and then at 3, 6, 12, and 24 months after surgery. Objective acoustic parameters analyzed during the same period included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, highest frequency, frequency and intensity range, and maximal phonation time.

Results

At 3 months after surgery, VSS was better in the robotic group than in the conventional group. At 2 years after surgery, VSS had recovered to the pre-operative level in the robotic group, whereas it remained significantly worse at 2 years in the conventional group. The phonatory frequency range and highest frequency were significantly wider and higher, respectively, in the robotic group than the conventional group at 6, 12, and 24 months post-operatively. Within the robotic group, the frequency range and highest frequency recovered to pre-operative levels by 6 months, whereas in the conventional group they remained below the pre-operative levels at 2 years post-operatively. There were no differences in other acoustic parameters between the two groups of patients at any period.

Conclusion

Up to 2 years post-operatively, robotic thyroidectomy has advantages in terms of recovery of voice symptoms and acoustic parameters over conventional thyroidectomy.

Keywords

Thyroid Nodule Recurrent Laryngeal Nerve Vocal Fold Conventional Group Acoustic Parameter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflict of interest

Chang Myeon Song, Bo Ram Yun, Yong Bae Ji, Eui Suk Sung, Kyung Rae Kim, and Kyung Tae have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ban EJ, Yoo JY, Kim WW et al (2014) Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 28:2555–2563PubMedCrossRefGoogle Scholar
  2. 2.
    Song CM, Cho YH, Ji YB et al (2013) Comparison of a gasless unilateral axillo-breast and axillary approach in robotic thyroidectomy. Surg Endosc 27:3769–3775PubMedCrossRefGoogle Scholar
  3. 3.
    Tae K, Ji YB, Jeong JH et al (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRefGoogle Scholar
  4. 4.
    Holsinger FC, Terris DJ, Kuppersmith RB (2010) Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation. Otolaryngol Clin North Am 43:381–388PubMedCrossRefGoogle Scholar
  5. 5.
    Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526PubMedCrossRefGoogle Scholar
  6. 6.
    Kandil E, Abdelghani S, Noureldine SI et al (2012) Transaxillary gasless robotic thyroidectomy: a single surgeon’s experience in North America. Arch Otolaryngol Head Neck Surg 138:113–117PubMedCrossRefGoogle Scholar
  7. 7.
    Lee KE, Kim E, Koo do H et al (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness. Surg Endosc 27:2955–2962PubMedCrossRefGoogle Scholar
  8. 8.
    Song CM, Ji YB, Bang HS et al (2014) Quality of life after robotic thyroidectomy by a gasless unilateral axillary approach. Ann Surg Oncol 21:4188–4194PubMedCrossRefGoogle Scholar
  9. 9.
    Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406PubMedCrossRefGoogle Scholar
  10. 10.
    Lee KE, Koo do H, Kim SJ et al (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148:1207–1213PubMedCrossRefGoogle Scholar
  11. 11.
    Lee S, Lee CR, Lee SC et al (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075PubMedCrossRefGoogle Scholar
  12. 12.
    Tae K, Song CM, Ji YB et al (2014) Comparison of surgical completeness between robotic total thyroidectomy versus open thyroidectomy. Laryngoscope 124:1042–1047PubMedCrossRefGoogle Scholar
  13. 13.
    Song CM, Ji YB, Bang HS et al (2014) Long-term sensory disturbance and discomfort after robotic thyroidectomy. World J Surg 38:1743–1748. doi: 10.1007/s00268-014-2456-8 PubMedCrossRefGoogle Scholar
  14. 14.
    Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404PubMedCrossRefGoogle Scholar
  15. 15.
    Pereira JA, Girvent M, Sancho JJ et al (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322PubMedCrossRefGoogle Scholar
  16. 16.
    Silva IC, Netto Ide P, Vartanian JG et al (2012) Prevalence of upper aerodigestive symptoms in patients who underwent thyroidectomy with and without the use of intraoperative laryngeal nerve monitoring. Thyroid 22:814–819PubMedCrossRefGoogle Scholar
  17. 17.
    Lee J, Nah KY, Kim RM et al (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194PubMedCrossRefGoogle Scholar
  18. 18.
    Tae K, Kim KY, Yun BR et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877PubMedCrossRefGoogle Scholar
  19. 19.
    Lee J, Na KY, Kim RM et al (2012) Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 19:2963–2970PubMedCrossRefGoogle Scholar
  20. 20.
    Tae K, Ji YB, Jeong JH et al (2013) Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. Head Neck 35:477–484PubMedCrossRefGoogle Scholar
  21. 21.
    Tae K, Ji YB, Cho SH et al (2012) Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck 34:617–625PubMedCrossRefGoogle Scholar
  22. 22.
    Bhattacharyya N, Fried MP (2002) Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 128:389–392PubMedCrossRefGoogle Scholar
  23. 23.
    Debruyne F, Ostyn F, Delaere P et al (1997) Acoustic analysis of the speaking voice after thyroidectomy. J Voice 11:479–482PubMedCrossRefGoogle Scholar
  24. 24.
    Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133PubMedCrossRefGoogle Scholar
  25. 25.
    Lee S, Ryu HR, Park JH et al (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253:1060–1066PubMedCrossRefGoogle Scholar
  26. 26.
    Ryu J, Ryu YM, Jung YS et al (2013) Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery 154:611–620PubMedCrossRefGoogle Scholar
  27. 27.
    Lombardi CP, Raffaelli M, De Crea C et al (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181PubMedCrossRefGoogle Scholar
  28. 28.
    Stojadinovic A, Shaha AR, Orlikoff RF et al (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Lombardi CP, Raffaelli M, D’Alatri L et al (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700. doi: 10.1007/s00268-007-9443-2 PubMedCrossRefGoogle Scholar
  30. 30.
    Lombardi CP, Raffaelli M, D’Alatri L et al (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1032PubMedCrossRefGoogle Scholar
  31. 31.
    Maeda T, Saito M, Otsuki N et al (2013) Voice quality after surgical treatment for thyroid cancer. Thyroid 23:847–853PubMedCrossRefGoogle Scholar
  32. 32.
    Kark AE, Kissin MW, Auerbach R et al (1984) Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J 289:1412–1415CrossRefGoogle Scholar
  33. 33.
    de Pedro Netto I, Fae A, Vartanian JG et al (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114CrossRefGoogle Scholar
  34. 34.
    McIvor NP, Flint DJ, Gillibrand J et al (2000) Thyroid surgery and voice-related outcomes. Aust N Z J Surg 70:179–183PubMedCrossRefGoogle Scholar
  35. 35.
    Dursun G, Sataloff RT, Spiegel JR et al (1996) Superior laryngeal nerve paresis and paralysis. J Voice 10:206–211PubMedCrossRefGoogle Scholar
  36. 36.
    Hong KH, Ye M, Kim YM et al (1997) The role of strap muscles in phonation–in vivo canine laryngeal model. J Voice 11:23–32PubMedCrossRefGoogle Scholar
  37. 37.
    Hirano M, Koike Y, von Leden H (1967) The sternohyoid muscle during phonation. Electromyographic studies. Acta Otolaryngol 64:500–507PubMedCrossRefGoogle Scholar
  38. 38.
    Soylu L, Ozbas S, Uslu HY et al (2007) The evaluation of the causes of subjective voice disturbances after thyroid surgery. Am J Surg 194:317–322PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Chang Myeon Song
    • 1
  • Bo Ram Yun
    • 1
  • Yong Bae Ji
    • 1
  • Eui Suk Sung
    • 1
  • Kyung Rae Kim
    • 1
  • Kyung Tae
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck Surgery, College of MedicineHanyang UniversitySeoulKorea

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