Advertisement

Surgical Endoscopy

, Volume 27, Issue 10, pp 3769–3775 | Cite as

Comparison of a gasless unilateral axillo-breast and axillary approach in robotic thyroidectomy

  • Chang Myeon Song
  • Yong Hee Cho
  • Yong Bae Ji
  • Jin Hyeok Jeong
  • Dong Sun Kim
  • Kyung TaeEmail author
Article

Abstract

Background

New approaches to robotic thyroidectomy help to prevent neck scarring and improve surgical ergonomics. The purpose of this study was to compare the efficacy and advantages of a gasless unilateral axillary (GUA) approach and an axillo-breast (GUAB) approach in robotic thyroidectomy.

Methods

We retrospectively reviewed the data of 131 patients who underwent robotic thyroidectomy with or without central neck dissection using a GUAB (90 cases) or GUA (41 cases) approach between September 2009 and December 2011. We excluded patients who underwent simultaneous lateral neck dissection and cases within the learning curve. We compared patient and tumor characteristics, surgical outcomes, perioperative complications, and cosmetic satisfaction between the two approaches.

Results

Robotic thyroidectomy was successful in all patients. There were no differences in terms of patient and tumor characteristics, extent of thyroidectomy and central neck dissection, operative time, and postoperative complications between the two approaches. Cosmetic satisfaction was excellent in both groups. There was no difference in satisfaction with the cosmetic result in the neck area, but the GUA patients expressed higher satisfaction with the appearance of the breast.

Conclusions

The surgical outcomes of GUA and GUAB approaches are similar in robotic thyroidectomy. Both are safe, effective, and yield cosmetically excellent results when performed by an experienced robotic thyroid surgeon. However, a GUA approach is associated with superior cosmetic satisfaction with the appearance of the breast.

Keywords

Robotic thyroidectomy da Vinci Surgical System Gasless unilateral axillo-breast approach Gasless unilateral axillary approach Endoscopic thyroidectomy Cosmesis 

Notes

Disclosures

Drs. Chang Myeon Song, Yong Hee Cho, Yong Bae Ji, Jin Hyeok Jeong, Dong Sun Kim, and Kyung Tae have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877PubMedCrossRefGoogle Scholar
  2. 2.
    Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4PubMedGoogle Scholar
  3. 3.
    Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340PubMedCrossRefGoogle Scholar
  4. 4.
    Gagner M, Inabnet WB 3rd (2001) Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 11:161–163PubMedCrossRefGoogle Scholar
  5. 5.
    Miccoli P, Berti P, Raffaelli M, Materazzi G, Baldacci S, Rossi G (2001) Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130:1039–1043PubMedCrossRefGoogle Scholar
  6. 6.
    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 Percutan Tech 13:196–201PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    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
  9. 9.
    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
  10. 10.
    Ryu HR, Kang SW, Lee SH, Rhee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211:e13–e19PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: patient selection and technical considerations. Surg Laparosc Endosc Percutan Tech 21:237–242PubMedCrossRefGoogle Scholar
  13. 13.
    Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526PubMedCrossRefGoogle Scholar
  14. 14.
    Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214:558–564PubMedCrossRefGoogle Scholar
  15. 15.
    Lee J, Kang SW, Jung JJ, Choi UJ, Yun JH, Nam KH, Soh EY, Chung WY (2011) Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18:2538–2547PubMedCrossRefGoogle Scholar
  16. 16.
    Tae K, Ji YB, Jeong JH, Kim KR, Choi WH, Ahn YH (2013) Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. Head Neck 35:477–484PubMedCrossRefGoogle Scholar
  17. 17.
    Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (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
  18. 18.
    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
  19. 19.
    Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS, Kim TW (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
  20. 20.
    O’Connell DA, Diamond C, Seikaly H, Harris JR (2008) Objective and subjective scar aesthetics in minimal access vs conventional access parathyroidectomy and thyroidectomy surgical procedures: a paired cohort study. Arch Otolaryngol Head Neck Surg 134:85–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Chang Myeon Song
    • 1
  • Yong Hee Cho
    • 1
  • Yong Bae Ji
    • 1
  • Jin Hyeok Jeong
    • 1
  • Dong Sun Kim
    • 2
  • Kyung Tae
    • 1
    Email author
  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