Annals of Surgical Oncology

, Volume 21, Issue 12, pp 3859–3864 | Cite as

Robotic Thyroidectomy for Cancer in the US: Patterns of Use and Short-Term Outcomes

  • Mohamed Abdelgadir Adam
  • Paul Speicher
  • John Pura
  • Michaela A. Dinan
  • Shelby D. Reed
  • Sanziana A. Roman
  • Julie A. Sosa
Endocrine Tumors



We describe nationally representative patterns of utilization and short-term outcomes from robotic versus open thyroidectomy for thyroid cancer.


Descriptive statistics and multivariable analysis were used to analyze patterns of use of robotic thyroidectomy from the National Cancer Database (2010–2011). Short-term outcomes were compared between patients undergoing robotic versus open thyroidectomy, while adjusting for confounders.


A total of 68,393 patients with thyroid cancer underwent thyroidectomy; 225 had robotic surgery and 57,729 underwent open surgery. Robotic thyroid surgery use increased by 30 % from 2010 to 2011 (p = 0.08). Robotic cases were reported from 93 centers, with 89 centers performing <10 robotic cases. Compared with the open group, the robotic group was younger (51 vs. 47 years; p < 0.01) and included more Asian patients (4 vs. 8 %; p = 0.006) and privately-insured patients (68 vs. 77 %; p = 0.01). Tumor size was similar between patients undergoing robotic versus open surgery. Total thyroidectomy was performed less frequently in the robotic group (67 vs. 84 % open; p < 0.0001). Patients were relatively more likely to undergo robotic surgery if they were female (odds ratio [OR] 1.6; p = 0.04), younger (OR 0.8/10 years; p < 0.0001), or underwent lobectomy (OR 2.4; p < 0.0001). In adjusted multivariable analysis, there were no differences in the number of lymph nodes removed or length of stay between groups; however, there was a non-significant increase in the incidence of positive margins with robotic thyroidectomy.


Use of robotic thyroidectomy for thyroid cancer is limited to a few institutions, with short-term outcomes that are comparable to open surgery. Multi-institutional studies should be undertaken to compare thyroidectomy-specific complications and long-term outcomes.


Thyroid Cancer Robotic Surgery Papillary Thyroid Cancer Positive Surgical Margin Robotic Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors report no conflicts of interest. The data used in this study are derived from a de-identified NCDB file. The ACS and the CoC have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.


  1. 1.
    Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317–22.PubMedCrossRefGoogle Scholar
  2. 2.
    American Cancer Society. Cancer facts & figures. 2013. Accessed 1 Mar 2014.
  3. 3.
    Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope. 2004;114(3):393–402.PubMedCrossRefGoogle Scholar
  4. 4.
    Hannan SA. The magnificent seven: a history of modern thyroid surgery. Int J Surg. 2006;4(3):187–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Giddings AE. The history of thyroidectomy. J R Soc Med. 1998;91 Suppl 33:3–6.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320–30.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Singer MC, Heffernan A, Terris DJ. Defining anatomical landmarks for robotic facelift thyroidectomy. World J Surg. 2014;38(1):92–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Song CM, Ji YB, Bang HS, Park CW, Kim H, Tae K. Long-term sensory disturbance and discomfort after robotic thyroidectomy. World J Surg. Epub 8 Feb 2014.Google Scholar
  9. 9.
    Nam KH, Owen R, Inabnet WB 3rd. Prevention of complications in transaxillary single-incision robotic thyroidectomy. Thyroid. 2012;22(12):1266–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Richmon JD, Holsinger FC, Kandil E, Moore MW, Garcia JA, Tufano RP. Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique. J Robot Surg. 2011;5(4):279–82.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Lee J, Kwon IS, Bae EH, Chung WY. Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab. 2013;98(7):2701–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Duh QY. Robot-assisted endoscopic thyroidectomy: has the time come to abandon neck incisions? Ann Surg. 2011;253(6):1067–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW. Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck. 2012;34(5):617–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee YM, Yi O, Sung TY, Chung KW, Yoon JH, Hong SJ. Surgical outcomes of robotic thyroid surgery using a double incision gasless transaxillary approach: analysis of 400 cases treated by the same surgeon. Head Neck. Epub 22 Aug 2013.Google Scholar
  15. 15.
    Kang SW, Park JH, Jeong JS, et al. Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech. 2011;21(4):223–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Perrier ND. Why I have abandoned robot-assisted transaxillary thyroid surgery. Surgery. 2012;152(6):1025–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Inabnet WB 3rd. Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid. 2012;22(10):988–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Noureldine SI, Jackson NR, Tufano RP, Kandil E. A comparative North American experience of robotic thyroidectomy in a thyroid cancer population. Langenbecks Arch Surg. 2013;398(8):1069–74.PubMedCrossRefGoogle Scholar
  19. 19.
    Raval MV, Bilimoria KY, Stewart AK, Bentrem DJ, Ko CY. Using the NCDB for cancer care improvement: an introduction to available quality assessment tools. J Surg Oncol. 2009;99(8):488–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Aliyev S, Taskin HE, Agcaoglu O, et al. Robotic transaxillary total thyroidectomy through a single axillary incision. Surgery. 2013;153(5):705–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Landry CS, Grubbs EG, Warneke CL, et al. Robot-assisted transaxillary thyroid surgery in the United States: is it comparable to open thyroid lobectomy? Ann Surg Oncol. 2012;19(4):1269–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Stevenson CE, Gardner DF, Grover AC. Patient factors affecting operative times for single-incision trans-axillary robotic-assisted (STAR) thyroid lobectomy: does size matter? Ann Surg Oncol. 2012;19(5):1460–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Kandil EH, Noureldine SI, Yao L, Slakey DP. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg. 2012;214(4):558–64; discussion 564–556.Google Scholar
  25. 25.
    Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope. 2011;121(3):521–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Landry CS, Grubbs EG, Morris GS, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery. 2011;149(4):549–55.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh EY. Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc. 2011;25(3):906–12.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee J, Yun JH, Nam KH, Soh EY, Chung WY. The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol. 2011;18(1):226–32.PubMedCrossRefGoogle Scholar
  29. 29.
    Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB. Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid. 2010;20(12):1327–32.PubMedCrossRefGoogle Scholar
  30. 30.
    Sun GH, Peress L, Pynnonen MA. Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg. 2014;150(4):520–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012;26(8):2259–66.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Mohamed Abdelgadir Adam
    • 1
  • Paul Speicher
    • 1
  • John Pura
    • 2
  • Michaela A. Dinan
    • 3
  • Shelby D. Reed
    • 3
  • Sanziana A. Roman
    • 1
  • Julie A. Sosa
    • 1
    • 3
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of BiostatisticsDuke UniversityDurhamUSA
  3. 3.Duke Clinical Research InstituteDuke UniversityDurhamUSA

Personalised recommendations