Surgical Endoscopy

, Volume 26, Issue 7, pp 1871–1877 | Cite as

Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy

  • Kyung TaeEmail author
  • Ki Yong Kim
  • Bo Ram Yun
  • Yong Bae Ji
  • Chul Won Park
  • Dong Sun Kim
  • Tae Wha Kim



Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy.


The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively.


Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups.


Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.


Axillo-breast approach Endoscopic thyroidectomy Postthyroidectomy syndrome Robotic thyroidectomy Swallowing Voice 



Kyung Tae, Ki Yong Kim, Yong Bae Ji, Chul Won Park, Dong Sun Kim, Tae Wha Kim, and Bo Ram Yun have no conflicts of interest or financial ties to disclose.


  1. 1.
    Kang SW, Lee SC, 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 146:1048–1055PubMedCrossRefGoogle Scholar
  2. 2.
    Lee KE, Koo do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK (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
  3. 3.
    Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRefGoogle Scholar
  4. 4.
    Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526PubMedCrossRefGoogle Scholar
  5. 5.
    Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2011). Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: two years’ experience. Head Neck. doi: 10.1002/hed.21782
  6. 6.
    Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 121:1636–1641PubMedCrossRefGoogle Scholar
  7. 7.
    Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364PubMedCrossRefGoogle Scholar
  8. 8.
    Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc 13:196–201CrossRefGoogle Scholar
  9. 9.
    Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606PubMedCrossRefGoogle Scholar
  10. 10.
    Tae K, Kim SY, Lee YS, Lee HS (2007) Gasless endoscopic thyroidectomy by an axillary approach: preliminary report. Korean J Otolaryngol 50:252–256Google Scholar
  11. 11.
    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using transaxillary approach: surgical outcomes of 581 patients. Endocr J 56:361–369PubMedCrossRefGoogle Scholar
  12. 12.
    Koh YW, Kim JW, Lee SW, Choi EC (2009) Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc 23:2053–2060PubMedCrossRefGoogle Scholar
  13. 13.
    Tae K, Ji YB, Cho SH, Kim KR, Kim DW, Kim DS (2011) Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:162–169PubMedCrossRefGoogle Scholar
  14. 14.
    Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332PubMedCrossRefGoogle Scholar
  15. 15.
    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 196:189–195PubMedCrossRefGoogle Scholar
  16. 16.
    Miccoli P, Rago R, Massi M, Panicucci E, Metelli MR, Berti P, Minuto MN (2010) Standard versus video-assisted thyroidectomy: objective postoperative pain evaluation. Surg Endosc 24:2415–2417PubMedCrossRefGoogle Scholar
  17. 17.
    Del Rio P, Berti M, Sommaruga L, Arcuri MF, Cataldo S, Sianesi M (2008) Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy: results of a prospective outcome study. Langenbecks Arch Surg 393:271–273PubMedCrossRefGoogle Scholar
  18. 18.
    Lombardi CP, Raffaelli M, D’alatri L, De Crea C, 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 32:693–700PubMedCrossRefGoogle Scholar
  19. 19.
    Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194PubMedCrossRefGoogle Scholar
  20. 20.
    Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404PubMedCrossRefGoogle Scholar
  21. 21.
    Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, Boyle JO, Shah JP, Brennan MF, Kraus DH (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832PubMedCrossRefGoogle Scholar
  22. 22.
    Debruyne F, Ostyn F, Delaere P, Wellens W (1997) Acoustic analysis of the speaking voice after thyroidectomy. J Voice 11:479–482PubMedCrossRefGoogle Scholar
  23. 23.
    Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322PubMedCrossRefGoogle Scholar
  24. 24.
    Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, Debonis DL, Curutchet HP (2004) Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 199:556–560PubMedCrossRefGoogle Scholar
  25. 25.
    de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, Testa JR, Nishimoto IN, Kowalski LP, Carrara-de Angelis E (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114PubMedCrossRefGoogle Scholar
  26. 26.
    Musholt TJ, Musholt PB, Garm J, Napiontek U, Keilmann A (2006) Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery 140:978–988PubMedCrossRefGoogle Scholar
  27. 27.
    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 140:1026–1032PubMedCrossRefGoogle Scholar
  28. 28.
    Lombardi CP, Raffaelli M, De Crea C, D’Alatri L, Maccora D, Marchese MR, Paludetti G, Bellantone R (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181PubMedCrossRefGoogle Scholar
  29. 29.
    Henry LR, Solomon NP, Howard R, Gurevich-Uvena J, Horst LB, Coppit G, Orlikoff R, Libutti SK, Shaha AR, Stojadinovic A (2008) The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol 15:2027–2033PubMedCrossRefGoogle Scholar
  30. 30.
    Van Lierde K, D’haeseleer E, Wuyts FL, Baudonck N, Bernaert L, Vermeersch H (2010) Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope 120:338–345PubMedGoogle Scholar
  31. 31.
    Robinson JL, Mandel S, Sataloff RT (2004) Objective voice measures in nonsinging patients with unilateral superior laryngeal nerve paresis. J Voice 19:665–667CrossRefGoogle Scholar
  32. 32.
    Dursun G, Sataloff RT, Spiegel JR, Mandel S, Heuer RJ, Risen DC (1996) Superior laryngeal nerve paresis and paralysis. J Voice 10:206–211PubMedCrossRefGoogle Scholar
  33. 33.
    Hong KH, Ye M, Kim YM, Kevorkian KF, Berke GS (1997) The role of strap muscles in phonation: in vivo canine laryngeal model. J Voice 11:23–32PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kyung Tae
    • 1
    Email author
  • Ki Yong Kim
    • 1
  • Bo Ram Yun
    • 1
  • Yong Bae Ji
    • 1
  • Chul Won Park
    • 1
  • Dong Sun Kim
    • 2
  • Tae Wha Kim
    • 2
  1. 1.Department of Otolaryngology-Head and Neck Surgery, College of MedicineHanyang UniversitySeoulKorea
  2. 2.Department of Internal Medicine, College of MedicineHanyang UniversitySeoulKorea

Personalised recommendations