Annals of Surgical Oncology

, Volume 18, Issue 9, pp 2538–2547 | Cite as

Multicenter Study of Robotic Thyroidectomy: Short-Term Postoperative Outcomes and Surgeon Ergonomic Considerations

  • Jandee Lee
  • Sang Wook Kang
  • Jeong Ju Jung
  • Un Jung Choi
  • Jong Ho Yun
  • Kee Hyun Nam
  • Euy-Young Soh
  • Woong Youn Chung
Endocrine Tumors



Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.

Materials and Methods

We reviewed the medical records of 2014 consecutive patients who underwent RT, conducted by 7 surgeons, at 4 centers between October 2007 and June 2010. Patient characteristics, perioperative clinical results, complications, and pathologic outcomes were analyzed. Moreover, surgeons were surveyed to gather data on musculoskeletal discomfort experienced during OT, ET, and RT.


Of the 2014 patients, 740 underwent total and 1274 subtotal thyroidectomy. Mean tumor diameter was 0.8 cm, and the mean number of retrieved central lymph nodes was 4.5 ± 3.9 (range 0–28). The rates of permanent recurrent laryngeal nerve injury and permanent hypocalcemia were 0.4 and 0.05%, respectively. Neck and/or back pain after OT, ET, and RT was experienced by 100, 85.7, and 28.6% of surgeons, respectively. When surgeons ranked the operative approaches in decreasing order of associated pain, 57.1% indicated ET > OT > RT, 28.6% selected OT > ET > RT, and 14.3% responded ET > RT > OT.


RT is a feasible and safe procedure that may facilitate radical cervical lymph node dissection. Moreover, for surgeons, the RT resulted in less musculoskeletal discomfort than did OT or ET. A larger prospective study, with a longer follow-up, is needed to determine whether RT offers real benefits for both patients and surgeons.


  1. 1.
    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009;23:2399–406.PubMedCrossRefGoogle Scholar
  2. 2.
    Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery. 2009;146:1048–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS. Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg. 2009;209:e1–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Lewis CM, Chung WY, Holsinger FC. Feasibility and surgical approach of transaxillary approach robotic thyroidectomy without CO(2) insufflation. Head Neck. 2010;32:121–6.PubMedGoogle Scholar
  5. 5.
    Berber E, Heiden K, Akyildiz H, Milas M, Mitchell J, Siperstein A. Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique. Surg Laparosc Endosc Percutan Tech. 2010;20:e60–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Landry CS, Grubbs EG, Stephen Morris G, Turner NS, Christopher Holsinger C, Lee JE, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery. doi:10.1016/j.surg.2010.08.014 [Epub ahead of print].
  7. 7.
    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. doi:10.1007/s00464-010-1296-3 [Epub ahead of print].
  8. 8.
    Lee J, Yun JH, Nam KH, Soh EY Chung WY. The learning curve for robotic thyroidectomy: A multicenter study. Ann Surg Oncol. doi:10.1245/s10434-010-1220-z [Epub ahead of print].
  9. 9.
    Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY. Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc. 2010;24:3186–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc. 2011;25:221–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Szeto GP, Ho P, Ting AC, Poon JT, Tsang RC, Cheng SW. A study of surgeon’s postural muscle activity during open, laparoscopic, and endovascular surgery. Surg Endosc. 2010;24:1712–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Berguer R, Forkey D, Smith WD. Ergonomic problems associated laparoscopic instruments. Surg Endosc. 1999;13:466–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Manukyan GA, Waseda M, Inaki N, Torres Bermudez JR, Gacek IA, Rudinski A, et al. Ergonomics with the use of curved versus straight laparoscopic graspers during rectosigmoid resection: results of a multiprofile comparative study. Surg Endosc. 2007;21:1079–89.PubMedCrossRefGoogle Scholar
  14. 14.
    Bagrodia A, Raman JD. Ergonomics considerations of radical prostatectomy: physician perspective of open, laparoscopic, and robot-assisted techniques. J Endourol. 2009;23:627–33.PubMedCrossRefGoogle Scholar
  15. 15.
    Mirbod SM, Yoshida H, Miyamoto K, Miyashita K, Inaba R, Iwata H. Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health. 1995;67:179–86.PubMedGoogle Scholar
  16. 16.
    Albayrak A, van Veelen MA, Prins JF, Snijders CJ, de Ridder H, Kazemier G. A newly designed ergonomic body support for surgeons. Surg Endosc. 2007;21:1835–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, et al. Multicenter study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol. 2010;17:1614–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  19. 19.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16:1480–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Bhattacharyya N, Fried MP. Benchmarks for mortality, morbidity, and length of stay for head and neck surgical procedures. Arch Otolaryngol Head Neck Surg. 2001;127:127–32.PubMedGoogle Scholar
  21. 21.
    Chisholm EJ, Kulinskaya E, Tolley NS. Systemic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 2009;119:1135–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Steinmuller T, Klupp J, Wenking S, Neuhaus P. Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg. 1999;384:50–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998;383:167–9.PubMedGoogle Scholar
  24. 24.
    Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg. 2008;32:1349–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Slotema ET, Sebag F, Henry JF. What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg. 2008;32:1325–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech. 2006;16:226–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Kurihara H. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg. 2004;28:1075–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Wauben LS, van Veelen MA, Gossot D, Goossens RH. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 2006;20:1268–74.PubMedCrossRefGoogle Scholar
  29. 29.
    Liberman AS, Shrier I, Gordon PH. Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc. 2005;19:1606–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil. 2009;19:175–84.PubMedCrossRefGoogle Scholar
  31. 31.
    van Veelen Ma, Kazemier G, Koopman J, Goossens RH, Meijer DW. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech. 2002;12:47–52.CrossRefGoogle Scholar
  32. 32.
    Matern U, Kuttler G, Giebmeyer C, Waller P, Faist M. Ergonomics aspects of five different types of laparoscopic instrument handles under dynamic conditions with respect to specific laparoscopic tasks: an electromyographic-based study. Surg Endosc. 2004;18:1231–41.PubMedCrossRefGoogle Scholar
  33. 33.
    Nguyen NT, Ho HS, Smith WD, Philipps C, Lewis C, De Vera RM, et al. An ergonomic evaluation of surgeons’ axial skeletal and upper extremity movements during laparoscopic and open surgery. Am J Surg. 2001;182:720–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Berguer R, Smith W. An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res. 2006;134:87–92.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Jandee Lee
    • 1
  • Sang Wook Kang
    • 2
  • Jeong Ju Jung
    • 2
  • Un Jung Choi
    • 3
  • Jong Ho Yun
    • 4
  • Kee Hyun Nam
    • 2
  • Euy-Young Soh
    • 1
  • Woong Youn Chung
    • 2
  1. 1.Department of SurgeryAjou University School of MedicineSuwonKorea
  2. 2.Department of SurgeryYonsei University College of MedicineSeoulKorea
  3. 3.Department of SurgeryWon-Kwang University School of MedicineIksanKorea
  4. 4.Department of SurgeryUlsan University School of MedicineSeoulKorea

Personalised recommendations