Abstract
Background
Graves’ disease represents a relative contraindication for robotic thyroidectomy due to increased vascularity with a higher risk of intraoperative bleeding. With a novel robotic instrumentation, however, it is possible to reduce this risk considerably.
Methods
A 30-year-old female patient with Graves’ disease and keloid-prone olive skin underwent a single-incision transaxillary robotic total thyroidectomy through the left axilla using an 8-mm Fenestrated bipolar forceps instead of the standard 8-mm ProGrasp forceps.
Results
Total blood loss was 25 ml, and robotic console time was 132 min. There was no postoperative recurrent palsy. Postoperative parathormone level was 47 ng/l (preop.: 56 ng/l), and serum calcium level was normal at 2,17 mmol/l (preop.: 2,23 mmol/l).
Conclusion
Transaxillary robotic surgery (TARS) with unilateral single-incision access is feasible and safe for Graves’ disease with minimal blood loss and reduced risk of conversion thanks to the bipolar capability of the 8-mm Fenestrated bipolar forceps.
This is a preview of subscription content, log in via an institution to check access.
References
Grodski S, Stalberg P, Robinson BG, Delbridge LW (2007) Surgery versus radioiodine therapy as definitive management for graves’ disease: the role of patient preference. Thyroid 17:157–160
Boostrom S, Richards ML (2007) Total thyroidectomy is the preferred treatment for patients with Graves’ disease and a thyroid nodule. Otolaryngol Head Neck Surg 136:278–281
Ku CF, Lo CY, Chan WF, Kung AW, Lam KS (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75:528–531
Liu J, Bargren A, Schaefer S, Chen H, Sippel RS (2011) Total thyroidectomy: a safe and effective treatment for Graves’ disease. J Surg Res 168:1–4
Berti P, Materazzi G, Galleri D, Donatini G, Minuto M, Miccoli P (2004) Video-assisted thyroidectomy for Graves’ disease: report of a preliminary experience. Surg Endosc 18:1208–1210
Sasaki A, Nitta H, Otsuka K, Obuchi T, Kurihara H, Wakabayashi G (2009) Endoscopic subtotal thyroidectomy: the procedure of choice for Graves’ disease? World J Surg 33:67–71
Yamamoto M, Sasaki A, Asahi H et al (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4
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, ix–x
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 25:221–228
Giannopoulos G, Kang SW, Jeong JJ, Nam KH, Chung WY (2013) Robotic thyroidectomy for benign thyroid diseases: a stepwise strategy to the adoption of robotic thyroidectomy (gasless, transaxillary approach). Surg Laparosc Endosc Percutan Tech 23:312–315
Noureldine SI, Yao L, Wavekar RR, Mohamed S, Kandil E (2013) Thyroidectomy for graves’ disease: a feasibility study of the robotic transaxillary approach. ORL J Otorhinolaryngol Relat Spec 75:350–356
Nam KH, Owen R, Inabnet WB 3rd (2012) Prevention of complications in transaxillary single-incision robotic thyroidectomy. Thyroid 22:1266–1274
Kwon H, Koo do H, Choi JY, Kim E, Lee KE, Youn YK (2013) Bilateral axillo-breast approach robotic thyroidectomy for Graves’ disease: an initial experience in a single institute. World J Surg 37:1576–1581
Terris DJ, Duke WS (2013) Robotic and remote access thyroidectomy: a time to pause. World J Surg 37:1582–1583
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
Park JH, Lee CR, Park S et al (2013) Initial experience with robotic gasless transaxillary thyroidectomy for the management of graves disease: comparison of conventional open versus robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 23:e173–e177
Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7
Seybt M, Kuppersmith RB, Holsinger FC, Terris DJ (2010) Robotic axillary thyroidectomy: multi-institutional clinical experience with the daVinci. Laryngoscope 120(Suppl 4):S182
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 34:617–625
Kang SW, Lee SC, Lee SH et al (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055
Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332
Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lörincz, B.B., Möckelmann, N. & Knecht, R. Single-incision transaxillary robotic total thyroidectomy for Graves’ disease: improved feasibility and safety with novel robotic instrumentation. Eur Arch Otorhinolaryngol 271, 3349–3353 (2014). https://doi.org/10.1007/s00405-014-3250-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-014-3250-9