Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients
- 466 Downloads
Transoral thyroid surgery is an ideal method for minimally invasive thyroidectomy, as there is less flap dissection during the procedure and no postoperative scars. Nonetheless, technical obstacles have precluded the wide dissemination of this procedure. We present the surgical procedures and outcomes of transoral robotic thyroidectomy (TORT).
From September 2012 to June 2016, we performed TORT at Korea University Hospital. We used three intraoral ports and a single axillary port for the system’s four robotic arms. The surgical outcomes were retrospectively reviewed.
Twenty-four female patients (mean age 39.6 ± 11.6 years; mean tumor size 1.0 ± 1.3 cm) underwent unilateral thyroid lobectomies with or without ipsilateral central neck dissection. Twenty patients had papillary thyroid carcinomas (PTC), three had benign nodules, and one had a follicular thyroid carcinoma. The mean surgical time was 232 ± 41 min; the mean hospital stay was 3.3 ± 0.8 days. The number of retrieved central lymph nodes in the PTC patients was 4.7 ± 3.2. There were no reports of transient or permanent vocal cord palsy, recurrence, or mortality during the median follow-up period of 16.8 months. Paresthesia of the lower lip and the chin due to mental nerve injury was observed in nine of the first 12 patients (six transient, three permanent), but no further reports of paresthesia were recorded after patient 12, when the locations of the intraoral incisions were modified.
TORT is feasible and safe for selected patients after technical refinements, and can be a potential alternative approach for scarless thyroid surgery.
KeywordsTransoral robotic thyroidectomy Transoral thyroidectomy Robotic thyroidectomy Thyroid carcinoma
We would like to thank Hong Kyu Kim for preparing the figures, and Ji Young Won and Woong Hyun Lee for the illustration.
This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean government (Ministry of Science, ICT & Future Planning, NRF-2016R1E1A1A01942072).
Compliance with ethical standards
Drs. Hoon Yub Kim, Young Jun Chai, Gianlorenzo Dionigi, Angkoon Anuwong, and Jeremy D. Richmon have no conflicts of interest or financial ties to disclose.
- 6.Nakajo A, Arima H, Hirata M, Mizoguchi T, Kijima Y, Mori S, Ishigami S, Ueno S, Yoshinaka H, Natsugoe S (2013) Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 27(4):1105–1110CrossRefPubMedGoogle Scholar
- 18.Chai YJ, Song J, Kang J, Woo JW, Song RY, Kwon H, Kim SJ, Choi JY, Lee KE (2016) A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad. Ann Surg Treat Res 90(5):239–245CrossRefPubMedPubMedCentralGoogle Scholar