Abstract
Purpose
This study seeks to explore the efficacy of robotic thyroidectomy in treating a North American population with differentiated thyroid cancer (DTC) as compared with the conventional cervical approach.
Methods
A retrospective analysis of our prospectively collected thyroid surgery database was performed. We included all consecutive patients that underwent thyroidectomy for the treatment of well-differentiated thyroid cancer, performed by a single surgeon.
Results
Twenty-four robotic transaxillary and 35 conventional thyroidectomy procedures were performed. Average size of the tumor was 1.1 ± 0.2 cm in the robotic group and 1.7 ± 0.3 cm in the cervical group (p = 0.16). Average total operative time for the robotic group was 133 ± 65.4 and 119.7 ± 22.5 min in the cervical group (p = 0.34). No robotic cases required conversion. One patient required reoperation for recurrent disease at 24 months follow-up. Both groups had similar blood loss (p = 0.37) and all margins were negative for malignancy on permanent pathology. All patients were discharged home within 24 h. Postoperative stimulated thyroglobulin levels were similar for the two groups (p = 0.82).
Conclusions
Our experience with robotic transaxillary thyroidectomy confirms this technique is feasible. It is possible to achieve a safe and effective oncologic result in a select group of North American patients with DTC.
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References
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83(6):875, Epub 1996/06/01. PubMed PMID: 8696772
Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11(8):877, Epub 1997/08/01. PubMed PMID: 9266657
Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15(11):1362–1364. doi:10.1007/s004640080139, Epub 2001/12/01. PubMed PMID: 11727158
Gagner M, Inabnet WB 3rd (2001) Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 11(2):161–163. doi:10.1089/105072501300042848, Epub 2001/04/06. PubMed PMID: 11288985
Miccoli P (2002) Minimally invasive surgery for thyroid and parathyroid diseases. Surg Endosc 16(1):3–6. doi:10.1007/s00464-001-8140-8, Epub 2002/04/19. PubMed PMID: 11961594
Cho YU, Park IJ, Choi KH, Kim SJ, Choi SK, Hur YS et al (2007) Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system. Yonsei Med J 48(3):480–487, Epub 2007/06/28. PubMed PMID: 17594157; PubMed Central PMCID: PMC2628087
Bellantone R, Lombardi CP, Raffaelli M, Rubino F, Boscherini M, Perilli W (1999) Minimally invasive, totally gasless video-assisted thyroid lobectomy. Am J Surg 177(4):342–343, Epub 1999/05/18. PubMed PMID: 10326857
Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS et al (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369
Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32(3):381–385. doi:10.1007/s00268-007-9375-x, Epub 2008/01/04. PubMed PMID: 18172709
Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2011) Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck. doi:10.1002/hed.21782, Epub 2011/06/21. PubMed PMID: 21688343
Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G et al (2001) Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg 136:822–827, United States
Tanna N, Joshi AS, Glade RS, Zalkind D, Sadeghi N (2006) Da Vinci robot-assisted endocrine surgery: novel applications in otolaryngology. Otolaryngol Head Neck Surg 135:633–635, United States
Miyano G, Lobe TE, Wright SK (2008) Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg 43:299–303, United States
Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS 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, United States
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 Percutan Tech 19:e71–e75, United States
Kang S-W, Jeong J, Yun J-S, Sung T, Lee S, Lee Y et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23(11):2399–2406. doi:10.1007/s00464-009-0366-x
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(12):3186–3194. doi:10.1007/s00464-010-1113-z, Epub 2010/05/22. PubMed PMID: 20490558
Lee KE, Koo Do H, Kim SJ, Lee J, Park KS, Oh SK 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(6):1207–1213. doi:10.1016/j.surg.2010.09.018, Epub 2010/12/08. PubMed PMID: 21134553
Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary Thyroidectomy: an examination of the first One hundred cases. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2012.01.002, Epub 2012/03/01. PubMed PMID: 22360981
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(12):1327–1332. doi:10.1089/thy.2010.1666, Epub 2010/12/01. PubMed PMID: 21114381
Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE et al (2011) Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149:549–555, United States: Inc
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214. doi:10.1089/thy.2009.0110, Epub 2009/10/29. PubMed PMID: 19860577
Kandil E, Abdelghani S, Noureldine SI, Friedlander P, Abdel Khalek M, Bellows CF et al (2012) Transaxillary gasless robotic Thyroidectomy: a single surgeon’s experience in North America. Arch Otolaryngol Head Neck Surg 138(2):113–117. doi:10.1001/archoto.2011.1082, Epub 2012/02/22. PubMed PMID: 22351858
Siegel R, Ward E, Brawley O, Jemal A. (2011) Cancer statistics
Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16(1):88–91. doi:10.1007/s004640080197, Epub 2002/04/19. PubMed PMID: 11961612
Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32(7):1349–1357. doi:10.1007/s00268-008-9555-3, Epub 2008/03/25. PubMed PMID: 18360737
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, United States
Holsinger FC, Terris DJ, Kuppersmith RB. (2010) Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation. Otolaryngol Clin North Am. 43. United States: 2010 Elsevier Inc. p. 381–8, ix-x
Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ et al (2012) Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery 151(5):724–730. doi:10.1016/j.surg.2011.12.013, Epub 2012/01/31. PubMed PMID: 22284763
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Presentation
The 8th International Conference on Head & Neck Cancer. July 21–25, 2012. Toronto, Ontario, Canada.
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The authors have no financial interests in companies or other entities that have an interest in the information included in the contribution. There are no financial disclosures.
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Authors’ contributions
Study conception and design: Kandil, Noureldine; acquisition of data: Noureldine, Jackson; analysis and interpretation of data: Kandil, Jackson, Noureldine; drafting of manuscript: Noureldine; and critical revision: Kandil, Tufano.
Synopsis: This study aims to explore the efficacy of robotic thyroidectomy in treating a North American population with differentiated thyroid cancer (DTC) as compared with the conventional cervical approach.
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Noureldine, S.I., Jackson, N.R., Tufano, R.P. et al. A comparative North American experience of robotic thyroidectomy in a thyroid cancer population. Langenbecks Arch Surg 398, 1069–1074 (2013). https://doi.org/10.1007/s00423-013-1123-0
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DOI: https://doi.org/10.1007/s00423-013-1123-0