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Long-Term Voice Outcomes After Robotic Thyroidectomy

World Journal of Surgery volume 40, pages 110–116 (2016)Cite this article

Abstract

Background

The purpose of this study was to evaluate the long-term voice function after robotic thyroidectomy in comparison with conventional transcervical thyroidectomy.

Methods

We prospectively evaluated the voice functions of 54 patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillary or axillo-breast approach and of 70 patients who underwent conventional thyroidectomy. Subjective voice symptom score (VSS) was evaluated in questionnaires before thyroidectomy and then at 3, 6, 12, and 24 months after surgery. Objective acoustic parameters analyzed during the same period included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, highest frequency, frequency and intensity range, and maximal phonation time.

Results

At 3 months after surgery, VSS was better in the robotic group than in the conventional group. At 2 years after surgery, VSS had recovered to the pre-operative level in the robotic group, whereas it remained significantly worse at 2 years in the conventional group. The phonatory frequency range and highest frequency were significantly wider and higher, respectively, in the robotic group than the conventional group at 6, 12, and 24 months post-operatively. Within the robotic group, the frequency range and highest frequency recovered to pre-operative levels by 6 months, whereas in the conventional group they remained below the pre-operative levels at 2 years post-operatively. There were no differences in other acoustic parameters between the two groups of patients at any period.

Conclusion

Up to 2 years post-operatively, robotic thyroidectomy has advantages in terms of recovery of voice symptoms and acoustic parameters over conventional thyroidectomy.

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References

  1. Ban EJ, Yoo JY, Kim WW et al (2014) Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 28:2555–2563

    PubMed  Article  Google Scholar 

  2. Song CM, Cho YH, Ji YB et al (2013) Comparison of a gasless unilateral axillo-breast and axillary approach in robotic thyroidectomy. Surg Endosc 27:3769–3775

    PubMed  Article  Google Scholar 

  3. Tae K, Ji YB, Jeong JH et al (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228

    PubMed  Article  Google Scholar 

  4. Holsinger FC, Terris DJ, Kuppersmith RB (2010) Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation. Otolaryngol Clin North Am 43:381–388

    PubMed  Article  Google Scholar 

  5. Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526

    PubMed  Article  Google Scholar 

  6. Kandil E, Abdelghani S, Noureldine SI et al (2012) Transaxillary gasless robotic thyroidectomy: a single surgeon’s experience in North America. Arch Otolaryngol Head Neck Surg 138:113–117

    PubMed  Article  Google Scholar 

  7. Lee KE, Kim E, Koo do H et al (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness. Surg Endosc 27:2955–2962

    PubMed  Article  Google Scholar 

  8. Song CM, Ji YB, Bang HS et al (2014) Quality of life after robotic thyroidectomy by a gasless unilateral axillary approach. Ann Surg Oncol 21:4188–4194

    PubMed  Article  Google Scholar 

  9. Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406

    PubMed  Article  Google Scholar 

  10. Lee KE, Koo do H, Kim SJ et al (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 148:1207–1213

    PubMed  Article  Google Scholar 

  11. Lee S, Lee CR, Lee SC et al (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075

    PubMed  Article  Google Scholar 

  12. Tae K, Song CM, Ji YB et al (2014) Comparison of surgical completeness between robotic total thyroidectomy versus open thyroidectomy. Laryngoscope 124:1042–1047

    PubMed  Article  Google Scholar 

  13. Song CM, Ji YB, Bang HS et al (2014) Long-term sensory disturbance and discomfort after robotic thyroidectomy. World J Surg 38:1743–1748. doi:10.1007/s00268-014-2456-8

    PubMed  Article  Google Scholar 

  14. Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404

    PubMed  CAS  Article  Google Scholar 

  15. Pereira JA, Girvent M, Sancho JJ et al (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322

    PubMed  Article  Google Scholar 

  16. Silva IC, Netto Ide P, Vartanian JG et al (2012) Prevalence of upper aerodigestive symptoms in patients who underwent thyroidectomy with and without the use of intraoperative laryngeal nerve monitoring. Thyroid 22:814–819

    PubMed  Article  Google Scholar 

  17. Lee J, Nah KY, Kim RM et al (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194

    PubMed  Article  Google Scholar 

  18. Tae K, Kim KY, Yun BR et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877

    PubMed  Article  Google Scholar 

  19. Lee J, Na KY, Kim RM et al (2012) Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 19:2963–2970

    PubMed  Article  Google Scholar 

  20. Tae K, Ji YB, Jeong JH et al (2013) Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. Head Neck 35:477–484

    PubMed  Article  Google Scholar 

  21. Tae K, Ji YB, Cho SH et al (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 34:617–625

    PubMed  Article  Google Scholar 

  22. Bhattacharyya N, Fried MP (2002) Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 128:389–392

    PubMed  Article  Google Scholar 

  23. Debruyne F, Ostyn F, Delaere P et al (1997) Acoustic analysis of the speaking voice after thyroidectomy. J Voice 11:479–482

    PubMed  CAS  Article  Google Scholar 

  24. Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133

    PubMed  Article  Google Scholar 

  25. Lee S, Ryu HR, Park JH et al (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253:1060–1066

    PubMed  Article  Google Scholar 

  26. Ryu J, Ryu YM, Jung YS et al (2013) Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery 154:611–620

    PubMed  Article  Google Scholar 

  27. Lombardi CP, Raffaelli M, De Crea C et al (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181

    PubMed  Article  Google Scholar 

  28. Stojadinovic A, Shaha AR, Orlikoff RF et al (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832

    PubMed  PubMed Central  Article  Google Scholar 

  29. Lombardi CP, Raffaelli M, D’Alatri L et al (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700. doi:10.1007/s00268-007-9443-2

    PubMed  Article  Google Scholar 

  30. Lombardi CP, Raffaelli M, D’Alatri L et al (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1032

    PubMed  Article  Google Scholar 

  31. Maeda T, Saito M, Otsuki N et al (2013) Voice quality after surgical treatment for thyroid cancer. Thyroid 23:847–853

    PubMed  Article  Google Scholar 

  32. Kark AE, Kissin MW, Auerbach R et al (1984) Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J 289:1412–1415

    CAS  Article  Google Scholar 

  33. de Pedro Netto I, Fae A, Vartanian JG et al (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114

    Article  Google Scholar 

  34. McIvor NP, Flint DJ, Gillibrand J et al (2000) Thyroid surgery and voice-related outcomes. Aust N Z J Surg 70:179–183

    PubMed  CAS  Article  Google Scholar 

  35. Dursun G, Sataloff RT, Spiegel JR et al (1996) Superior laryngeal nerve paresis and paralysis. J Voice 10:206–211

    PubMed  CAS  Article  Google Scholar 

  36. Hong KH, Ye M, Kim YM et al (1997) The role of strap muscles in phonation–in vivo canine laryngeal model. J Voice 11:23–32

    PubMed  CAS  Article  Google Scholar 

  37. Hirano M, Koike Y, von Leden H (1967) The sternohyoid muscle during phonation. Electromyographic studies. Acta Otolaryngol 64:500–507

    PubMed  CAS  Article  Google Scholar 

  38. Soylu L, Ozbas S, Uslu HY et al (2007) The evaluation of the causes of subjective voice disturbances after thyroid surgery. Am J Surg 194:317–322

    PubMed  Article  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea

    Chang Myeon Song, Bo Ram Yun, Yong Bae Ji, Eui Suk Sung, Kyung Rae Kim & Kyung Tae

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  1. Chang Myeon Song
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  2. Bo Ram Yun
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  3. Yong Bae Ji
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Correspondence to Kyung Tae.

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Conflict of interest

Chang Myeon Song, Bo Ram Yun, Yong Bae Ji, Eui Suk Sung, Kyung Rae Kim, and Kyung Tae have no conflicts of interest or financial ties to disclose.

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Song, C.M., Yun, B.R., Ji, Y.B. et al. Long-Term Voice Outcomes After Robotic Thyroidectomy. World J Surg 40, 110–116 (2016). https://doi.org/10.1007/s00268-015-3264-5

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  • DOI: https://doi.org/10.1007/s00268-015-3264-5

Keywords

  • Thyroid Nodule
  • Recurrent Laryngeal Nerve
  • Vocal Fold
  • Conventional Group
  • Acoustic Parameter