Surgical Endoscopy

, Volume 30, Issue 9, pp 3861–3866 | Cite as

Comparison of postoperative surgical stress following robotic thyroidectomy and open thyroidectomy: a prospective pilot study

  • Se Hyun Paek
  • Kyung Ho Kang
  • Hyun Kang
  • Sung Jun Park



Robotic thyroid surgery using the da Vinci surgical system has certain cosmetic advantages; however, the invasiveness of robotic thyroid surgery is still a concern to many surgeons. Previous research has not directly compared the surgical stress of robotic thyroidectomy with that of conventional open surgery. The aim of the present study was to evaluate surgical stress using postsurgical measurements of several clinical markers.


A pilot study was performed to evaluate surgical stress following robotic and open thyroid surgery. A total of 29 papillary thyroid cancer patients from July to November 2014 were enrolled. Fourteen patients underwent conventional open surgery, and fifteen underwent robotic thyroidectomy. IL-6 levels, serum WBC counts, CRP levels, surgical plethysmographic index (SPI), and visual analogue scale (VAS) score were measured to compare surgical stress between the robotic and the open surgery groups.


No significant differences were seen between the two groups in IL-6 level, WBC count or CRP level (p = 0.380, 0.374, 0.360, respectively). Mean SPI level during the surgery was 41.9 ± 4.7 in open group compared to 39.5 ± 2.2 in robotic group, though this finding showed borderline significance (p = 0.095). VAS score after open surgery was significantly higher than after robotic operation (p = 0.048).


The results of this study suggest that robotic thyroidectomy can result in a less than equivocal systemic stress response than is seen in open thyroidectomy. However, further investigation including large-scale, prospective, multicenter studies is warranted for non-inferiority trials.


Surgical stress Robotic thyroidectomy IL-6 SPI VAS 


Compliance with ethical standards


Se Hyun Paek, Kyung Ho Kang, Hyun Kang, and Sung Jun Park have no conflicts of interest or financial ties to disclose. Ildong Pharmaceutical Company was not directly involved in the study design, data acquisition/interpretation, or manuscript preparation or review. Any opinions expressed herein do not necessarily reflect the opinions of Ildong Pharmaceutical Company.


  1. 1.
    Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R (2013) Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013:965212CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, Zhang Y, Bai Y, Zhu C, Guo GL, Rothman N, Zhang Y (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20:525–531CrossRefPubMedGoogle Scholar
  3. 3.
    Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, Devesa SS (2009) Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomark Prev 18:784–791CrossRefGoogle Scholar
  4. 4.
    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 31:601–606CrossRefPubMedGoogle Scholar
  5. 5.
    Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutaneous Tech 19:e71–e75CrossRefGoogle Scholar
  6. 6.
    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 24:3186–3194CrossRefPubMedGoogle Scholar
  7. 7.
    Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2012) Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery 151:724–730CrossRefPubMedGoogle Scholar
  8. 8.
    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 18:2538–2547CrossRefPubMedGoogle Scholar
  9. 9.
    Sun GH, Peress L, Pynnonen MA (2014) Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg 150:520–532CrossRefPubMedGoogle Scholar
  10. 10.
    Inabnet WB 3rd (2012) Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid 22:988–990CrossRefPubMedGoogle Scholar
  11. 11.
    Wang M, Zhang T, Mao Z, Dong F, Li J, Lu A, Hu W, Zang L, Jiang Y, Zheng M (2009) Effect of endoscopic thyroidectomy via anterior chest wall approach on treatment of benign thyroid tumors. J Laparoendosc Adv Surg Tech A 19:149–152CrossRefPubMedGoogle Scholar
  12. 12.
    Weissman C (1990) The metabolic response to stress: an overview and update. Anesthesiology 73:308–327CrossRefPubMedGoogle Scholar
  13. 13.
    Grande M, Tucci GF, Adorisio O, Barini A, Rulli F, Neri A, Franchi F, Farinon AM (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316CrossRefPubMedGoogle Scholar
  14. 14.
    Wortel CH, van Deventer SJ, Aarden LA, Lygidakis NJ, Buller HR, Hoek FJ, Horikx J, ten Cate JW (1993) Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery 114:564–570PubMedGoogle Scholar
  15. 15.
    Ohzato H, Yoshizaki K, Nishimoto N, Ogata A, Tagoh H, Monden M, Gotoh M, Kishimoto T, Mori T (1992) Interleukin-6 as a new indicator of inflammatory status: detection of serum levels of interleukin-6 and C-reactive protein after surgery. Surgery 111:201–209PubMedGoogle Scholar
  16. 16.
    Ueo H, Honda M, Adachi M, Inoue H, Nakashima H, Arinaga S, Akiyoshi T (1994) Minimal increase in serum interleukin-6 levels during laparoscopic cholecystectomy. Am J Surg 168:358–360CrossRefPubMedGoogle Scholar
  17. 17.
    Huiku M, Uutela K, van Gils M, Korhonen I, Kymalainen M, Merilainen P, Paloheimo M, Rantanen M, Takala P, Viertio-Oja H, Yli-Hankala A (2007) Assessment of surgical stress during general anaesthesia. Br J Anaesth 98:447–455CrossRefPubMedGoogle Scholar
  18. 18.
    Wennervirta J, Hynynen M, Koivusalo AM, Uutela K, Huiku M, Vakkuri A (2008) Surgical stress index as a measure of nociception/antinociception balance during general anesthesia. Acta Anaesthesiol Scand 52:1038–1045CrossRefPubMedGoogle Scholar
  19. 19.
    Chen X, Thee C, Gruenewald M, Ilies C, Hocker J, Hanss R, Steinfath M, Bein B (2012) Correlation of surgical pleth index with stress hormones during propofol-remifentanil anaesthesia. Sci World J 2012:879158Google Scholar
  20. 20.
    Struys MM, Vanpeteghem C, Huiku M, Uutela K, Blyaert NB, Mortier EP (2007) Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth 99:359–367CrossRefPubMedGoogle Scholar
  21. 21.
    de Boer AG, van Lanschot JJ, Stalmeier PF, van Sandick JW, Hulscher JB, de Haes JC, Sprangers MA (2004) Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res 13:311–320CrossRefPubMedGoogle Scholar
  22. 22.
    Kim BS, Kang KH, Park SJ (2015) Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis. Head Neck 37:37–45CrossRefGoogle Scholar
  23. 23.
    Kim HY, Choi YJ, Yu HN, Yoon SZ (2012) Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases. World J Surg Oncol 10:202CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Se Hyun Paek
    • 1
  • Kyung Ho Kang
    • 2
  • Hyun Kang
    • 3
  • Sung Jun Park
    • 2
  1. 1.Department of SurgerySchool of Medicine, Mokdong Hospital, Ewha Womans UniversitySeoulKorea
  2. 2.Department of SurgeryChung-Ang University Hospital and Chung-Ang University College of MedicineSeoulRepublic of Korea
  3. 3.Department of AnesthesiologyChung-Ang University Hospital and Chung-Ang University College of MedicineSeoulRepublic of Korea

Personalised recommendations