Abstract
Background
Bilateral axillo-breast approach (BABA) robotic thyroidectomy has shown excellent cosmetic and surgical outcomes. The aim of the present study was to evaluate the safety, feasibility, and initial outcome of this procedure in patients with Graves’ disease.
Methods
From June 2008 to July 2001, a total of 30 patients with Graves’ disease were reviewed retrospectively. Patient demographics, operative indications, and surgical variables, including operative time, blood loss, excised thyroid weight, and complications, were collected and investigated.
Results
The thyroidectomies were classified as total (n = 21), near-total (n = 6), or subtotal (n = 3). There were five indications for surgery: concomitant thyroid carcinoma or suspicious nodule (n = 22), recurrence after antithyroid medication (n = 2), local compressive symptoms (n = 1), patient’s preference (n = 4), and side effects of antithyroid medication (n = 1). The mean operative time, console time, blood loss, and excised thyroid weight were 190 min (range: 105–298 min), 113 min (range: 60–227 min), 229 mL (range: 50–550 mL), and 36.6 g (range: 7.8–123.0 g), respectively. There were no cases of postoperative bleeding or conversions to open surgery. Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 13 (43.3 %) and 4 (13.3 %) cases. Permanent hypoparathyroidism occurred in 1 (3.3 %) case. All patients were satisfied with the cosmetic outcomes.
Conclusions
BABA robotic thyroidectomy is a feasible and safe treatment for Graves’ disease. It is recommended as an alternative for patients who are concerned by the cosmetic effects of traditional thyroidectomy.
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References
Sasaki A, Nitta H, Otsuka K et al (2009) Endoscopic subtotal thyroidectomy: the procedure of choice for Graves’ disease? World J Surg 33:67–71. doi:10.1007/s00268-008-9783-6
Bahn Chair RS, Burch HB, Cooper DS et al (2011) Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 21:593–646
Yamamoto M, Sasaki A, Asahi H et al (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4
Berti P, Materazzi G, Galleri D et al (2004) Video-assisted thyroidectomy for Graves’ disease: report of a preliminary experience. Surg Endosc 18:1208–1210
Maeda S, Uga T, Hayashida N et al (2006) Video-assisted subtotal or near-total thyroidectomy for Graves’ disease. Br J Surg 93:61–66
Li ZY, Wang P, Wang Y et al (2010) Endoscopic thyroidectomy via breast approach for patients with Graves’ disease. World J Surg 34:2228–2232. doi:10.1007/s00268-010-0662-6
Lee J, Lee JH, Nah KY et al (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446
Choe JH, Kim SW, Chung KW et al (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606. doi:10.1007/s00268-006-0481-y
Choi JY, Lee KE, Chung KW et al (2012) Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc 26:948–955
Lee KE, Koo DH, Im HJ et al (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150:1266–1274
Lee KE, Choi JY, Youn YK (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:230–236
Huscher CS, Chiodini S, Napolitano C et al (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877
Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4
Ikeda Y, Takami H, Niimi M et al (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364
Shimazu K, Shiba E, Tamaki Y et al (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201
Sasaki A, Nakajima J, Ikeda K et al (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385. doi:10.1007/s00268-007-9375-x
Kandil E, Noureldine S, Abdel Khalek M et al (2011) Initial experience using robot- assisted transaxillary thyroidectomy for Graves’ disease. J Visc Surg 148:e447–e451
Youn YK, Oh SK (2011) Surgical treatment for Graves’ disease. In: Oh YC (ed) Surgery of the thyroid and parathyroid glands. SNU Press, Seoul, pp 247–257
Witte J, Goretzki PE, Dotzenrath C et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World J Surg 24:1303–1311. doi:10.1007/s002680010216
Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90:161–165
Efremidou EI, Papageorgiou MS, Liratzopoulos N et al (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52:39–44
Conflict of interest
Drs. Kwon, Koo, Choi, Kim, Lee, and Youn have no conflicts of interest or financial ties to disclose.
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Kwon, H., Koo, D.H., Choi, J.Y. et al. Bilateral Axillo-Breast Approach Robotic Thyroidectomy for Graves’ Disease: An Initial Experience in a Single Institute. World J Surg 37, 1576–1581 (2013). https://doi.org/10.1007/s00268-013-2027-4
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DOI: https://doi.org/10.1007/s00268-013-2027-4