Advertisement

Surgical Endoscopy

, Volume 24, Issue 12, pp 3186–3194 | Cite as

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

  • Jandee Lee
  • Kuk Young Nah
  • Ra Mi Kim
  • Yeun Hee Ahn
  • Euy-Young Soh
  • Woong Youn Chung
Article

Abstract

Background

Robotic thyroidectomy using a gasless transaxillary approach, first described in 2008, has become popular. This study compared outcomes, including postoperative distress and patient satisfaction, for patients undergoing robotic thyroidectomy with those for patients treated by conventional open thyroidectomy.

Methods

Of 84 prospectively enrolled patients, 41 underwent robotic thyroidectomy (the robot group), and 43 received conventional open thyroidectomy (the open group). All the patients were followed up for at least 3 months after surgery. Videolaryngostroboscopic examinations were performed preoperatively and after 1 week and after 3 months postoperatively. Postoperative pain and discomfort were evaluated using a symptom scale. Subjective voice and swallowing changes were assessed by questionnaires; and satisfaction with cosmetic outcome was measured by verbal response at 3 months.

Results

The two groups were similar in age, gender, type of operation, and final pathologic diagnosis. Although the mean operating time was significantly longer with the robotic technique than with open surgery, there were no between-group differences in postoperative pain or duration of hospital stay. No patient in either group experienced any major postoperative complication. Postoperative discomfort in the neck and swallowing disturbances were significantly more frequent in the open group than in the robot group, both at 1 week and at 3 months after surgery. However, there was no significant between-group difference in subjective voice parameters. At 3 months, the mean cosmetic satisfaction score was significantly higher in the robotic than in the open group.

Conclusion

Although postoperative pain levels and complications were comparable in the two groups, conventional open thyroidectomy requires a shorter operative time. The robotic technique, however, offers several distinct advantages including very good to excellent cosmetic results, reduced postoperative neck discomfort, and fewer adverse swallowing symptoms.

Keywords

Comparative study Cosmetic result Postoperative neck discomfort Robotic thyroidectomy Swallowing symptom 

Notes

Disclosures

Jandee Lee, Kuk Young Nah, Ra Mi Kim, Yeun Hee Ahn, Euy-Young Soh, Woong Youn Chung have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, Bellantone R (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1034CrossRefPubMedGoogle Scholar
  2. 2.
    Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322CrossRefPubMedGoogle Scholar
  3. 3.
    Akyildiz S, Ogut F, Akyildiz M, Engin EZ (2008) A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury. Arch Otolaryngol Head Neck Surg 134:596–602CrossRefPubMedGoogle Scholar
  4. 4.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195CrossRefPubMedGoogle Scholar
  5. 5.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Kurihara H (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 28:1075–1078CrossRefPubMedGoogle Scholar
  6. 6.
    Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg 31:2302–2308CrossRefPubMedGoogle Scholar
  7. 7.
    Jeong JJ, Kang SW, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol 100:477–480CrossRefPubMedGoogle Scholar
  8. 8.
    Koh YW, Park JH, Kim JW, Lee SW, Choi EC (2010) Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Surg Endosc 24:188–197CrossRefPubMedGoogle Scholar
  9. 9.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRefPubMedGoogle Scholar
  10. 10.
    Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right lobectomy. Surg Endosc 11:877CrossRefPubMedGoogle Scholar
  11. 11.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies: endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745CrossRefPubMedGoogle Scholar
  12. 12.
    Kang SW, Lee CH, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055CrossRefPubMedGoogle Scholar
  13. 13.
    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the 100 patients. Surg Endosc 23:2399–2406CrossRefPubMedGoogle Scholar
  14. 14.
    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:e1–e7CrossRefPubMedGoogle Scholar
  15. 15.
    Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robotic system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:71–75CrossRefGoogle Scholar
  16. 16.
    Lewis CM, Chung WY, Holsinger FC (2010) Feasibility and surgical approach of transaxillary approach robotic thyroidectomy without CO2 insufflation. Head Neck 32:121–126PubMedGoogle Scholar
  17. 17.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefPubMedGoogle Scholar
  18. 18.
    Lifante J-C, McGill J, Murry T, Aviv JE, Inabnet WB III (2009) A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation. Surgery 146:1167–1173CrossRefPubMedGoogle Scholar
  19. 19.
    Deary IJ, Webb A, MacKenzie K, Wilson JA, Carding PN (2004) Short, self-report voice symptom scales: psychometric characteristics of the Voice Handicap Index-10 and the vocal performance questionnaire. Otolaryngol Head Neck Surg 131:232–235CrossRefPubMedGoogle Scholar
  20. 20.
    Rosen CA, Lee AS, Osborne J, Zullo T, Murry T (2004) Development and validation of the Voice Handicap Index-10. Laryngoscope 114:1549–1556CrossRefPubMedGoogle Scholar
  21. 21.
    Lombardi CP, Raffaelli M, D’Alatri L, Crea CD, Marchese MR, Maccora D, Paludetti G, Bellantone R (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700CrossRefPubMedGoogle Scholar
  22. 22.
    Jayaraman S, Quan D, Al-Ghamdi I, El-Deen F, Schlachta CM (2009) Does robotic assistance improve efficiency in performing complex minimally invasive surgical procedures? Surg Endosc. doi: 10.1007/s00464-009-0621-1
  23. 23.
    Colonna M, Guizard AV, Schvartz C, Velten M, Raverdy N, Molinie F, Delafosse P, Franc B, Grosclaude P (2007) A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur J Cancer 43:891–900CrossRefPubMedGoogle Scholar
  24. 24.
    Gal I, Solymosi T, Szabo Z, Balint A, Bolgar G (2008) Minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surg Endosc 22:2445–2449CrossRefPubMedGoogle Scholar
  25. 25.
    Liu S, Qiu M, Jiang D-Z, Zheng X-M, Zhang W, Shen HL, Shan CX (2009) The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc 23:1802–1806CrossRefPubMedGoogle Scholar
  26. 26.
    Defechereux T, Rinken F, Maweja S, Hamoir E, Meurisse M (2003) Evaluation of the ultrasonic dissector in thyroid surgery: a prospective randomized study. Acta Chir Belg 103:274–277PubMedGoogle Scholar
  27. 27.
    Miccoli P, Berti P, Dionigi G, D’Agostino J, Orlandini C, Donatini G (2006) Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg 132:1069–1073CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jandee Lee
    • 1
  • Kuk Young Nah
    • 1
  • Ra Mi Kim
    • 1
  • Yeun Hee Ahn
    • 1
  • Euy-Young Soh
    • 1
  • Woong Youn Chung
    • 2
  1. 1.Department of SurgeryAjou University School of MedicineSuwonSouth Korea
  2. 2.Department of SurgeryYonsei University College of MedicineSeuolSouth Korea

Personalised recommendations