Skip to main content
SpringerLink
Log in

Surgical safety and oncological completeness of robotic thyroidectomy for thyroid carcinoma larger than 2 cm

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The safety of robotic thyroidectomy (RT) for small-sized thyroid carcinomas has been well established. The surgical outcomes of bilateral axillo-breast approach RT for thyroid carcinomas larger than 2 cm were evaluated and compared with those of open thyroidectomy (OT).

Methods

The medical records of patients who underwent total thyroidectomy or hemithyroidectomy followed by completion thyroidectomy for differentiated thyroid carcinomas measuring 2–4 cm were retrospectively reviewed.

Results

The study included 86 patients who underwent RT (n = 21) or OT (n = 65) with mean ages of 30.8 and 51.6 years, respectively. The mean tumor size was 2.8 cm in both groups. There were no significant differences between the RT and OT groups in vocal cord palsy rate (transient, 19.0 vs. 9.2 %; permanent, 0 vs. 1.5 %), postoperative hypoparathyroidism rate (transient, 19.0 vs. 33.8 %; permanent, 4.8 vs. 1.5 %), and the number of retrieved central lymph nodes in papillary thyroid carcinoma patients (6.4 ± 3.5 vs. 6.1 ± 3.9, respectively). The proportion of the patients with serum stimulated thyroglobulin level of <1.0 ng/ml at the initial radioactive iodine treatment was 64.7 % (11/17) for RT group and 66.0 % (35/53) for OT group (p = 0.920). There were three patients (1 RT and 2 OT) who had a biochemical incomplete response, and there was no case of anatomical recurrence or mortality during the median follow-up period of 40.2 months.

Conclusion

RT is a safe and oncologically sound treatment option for differentiated thyroid carcinomas measuring 2–4 cm in a selected group of patients. The role of RT should be evaluated in correlation with technological advances and increased experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295(18):2164–2167

    Article  CAS  PubMed  Google Scholar 

  2. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83(6):875

    Article  CAS  PubMed  Google Scholar 

  3. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146(6):1048–1055

    Article  PubMed  Google Scholar 

  4. 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(3):e71–75

    Article  PubMed  Google Scholar 

  5. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31(3):601–606

    Article  PubMed  Google Scholar 

  6. Kim HY, d’Ajello F, Woo SU, Son GS, Lee JB, Bae JW (2012) Robotic thyroid surgery using bilateral axillo-breast approach: personal initial experience over two years. Minerva Chir 67(1):39–48

    CAS  PubMed  Google Scholar 

  7. Lee KE, Kim E, Koo do H, Choi JY, Kim KH, Youn YK (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness. Surg Endosc 27(8):2955–2962

    Article  PubMed  Google Scholar 

  8. Lee KE, Koo do H, Im HJ, Park SK, Choi JY, Paeng JC, Chung JK, Oh SK, Youn YK (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150(6):1266–1274

    Article  PubMed  Google Scholar 

  9. Lee KE, Koo do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK (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

    Article  PubMed  Google Scholar 

  10. Haugen BRM, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RMM, Wartofsky L (2015) American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid

  11. Chai YJ, Kim SJ, Kim SC, Koo do H, Min HS, Lee KE, Kim JH, Youn YK (2014) BRAF mutation in follicular variant of papillary thyroid carcinoma is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography. Clin Endocrinol (Oxf) 81(3):432–439

    Article  CAS  Google Scholar 

  12. Yi O, Yoon JH, Lee YM, Sung TY, Chung KW, Kim TY, Kim WB, Shong YK, Ryu JS, Hong SJ (2013) Technical and oncologic safety of robotic thyroid surgery. Ann Surg Oncol 20(6):1927–1933

    Article  PubMed  Google Scholar 

  13. Tae K, Song CM, Ji YB, Kim KR, Kim JY, Choi YY (2014) Comparison of surgical completeness between robotic total thyroidectomy versus open thyroidectomy. Laryngoscope 124(4):1042–1047

    Article  PubMed  Google Scholar 

  14. Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY (2014) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope

  15. Kim WW, Jung JH, Park HY (2014) A single surgeon’s experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach. J Surg Oncol

  16. Jackson NR, Yao L, Tufano RP, Kandil EH (2014) Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck 36(1):137–143

    Article  PubMed  Google Scholar 

  17. Chai YJ, Lee KE, Youn YK (2014) Can robotic thyroidectomy be performed safely in thyroid carcinoma patients? Endocrinol Metab (Seoul) 29(3):226–232

    Article  Google Scholar 

  18. Noureldine SI, Jackson NR, Tufano RP, Kandil E (2013) A comparative North American experience of robotic thyroidectomy in a thyroid cancer population. Langenbecks Arch Surg 398(8):1069–1074

    Article  PubMed  Google Scholar 

  19. Ban EJ, Yoo JY, Kim WW, Son HY, Park S, Lee SH, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2014) Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc

  20. Ito Y, Fukushima M, Higashiyama T, Kihara M, Takamura Y, Kobayashi K, Miya A, Miyauchi A (2013) Tumor size is the strongest predictor of microscopic lymph node metastasis and lymph node recurrence of N0 papillary thyroid carcinoma. Endocr J 60(1):113–117

    Article  PubMed  Google Scholar 

  21. 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(5):617–625

    Article  PubMed  Google Scholar 

  22. Kim BS, Kang KH, Kang H, Park SJ (2014) Central neck dissection using a bilateral axillo-breast approach for robotic thyroidectomy: comparison with conventional open procedure after propensity score matching. Surg Laparosc Endosc Percutan Tech 24(1):67–72

    Article  PubMed  Google Scholar 

  23. Kwak HY, Kim HY, Lee HY, Jung SP, Woo SU, Son GS, Lee JB, Bae JW (2014) Robotic thyroidectomy using bilateral axillo-breast approach: Comparison of surgical results with open conventional thyroidectomy. J Surg Oncol

  24. Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY (2014) A Systematic Review and Meta-analysis Comparing Surgically-Related Complications between Robotic-Assisted Thyroidectomy and Conventional Open Thyroidectomy. Ann Surg Oncol 21(3):850–861

    Article  PubMed  Google Scholar 

  25. Schneider R, Randolph GW, Sekulla C, Phelan E, Thanh PN, Bucher M, Machens A, Dralle H, Lorenz K (2013) Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 35(11):1591–1598

    Article  PubMed  Google Scholar 

  26. Lee S, Park S, Lee CR, Son H, Kim J, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2013) The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 27(7):2407–2414

    Article  PubMed  Google Scholar 

  27. Lee J, Yun JH, Choi UJ, Kang SW, Jeong JJ, Chung WY (2012) Robotic versus endoscopic thyroidectomy for thyroid cancers: a multi-institutional analysis of early postoperative outcomes and surgical learning curves. J Oncol 2012(734541

  28. Lee J, Yun JH, Nam KH, Soh EY, Chung WY (2011) The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol 18(1):226–232

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by the Korean Foundation for Cancer Research (Grant Number CB-2011-03-01), and the Ministry of Science, ICT and Future Planning, Republic of Korea (Grant Number 2015R1C1A1A01055464).

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-70, Korea

      Young Jun Chai

    2. Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

      Young Jun Chai, Hyeong Won Yu, Ra-Yeong Song, Hyungju Kwon & Kyu Eun Lee

    3. Department of Surgery, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA

      Hyunsuk Suh

    4. Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

      Jung-Woo Woo, Hyeong Won Yu, Ra-Yeong Song, Hyungju Kwon & Kyu Eun Lee

    5. Department of Surgery, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine, Changwon, 514-72, Korea

      Jung-Woo Woo

    Authors
    1. Young Jun Chai
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Hyunsuk Suh
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jung-Woo Woo
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Hyeong Won Yu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Ra-Yeong Song
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Hyungju Kwon
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Kyu Eun Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Kyu Eun Lee.

    Ethics declarations

    Disclosures

    Young Jun Chai, Hyunsuk Suh, Jung-Woo Woo, Hyeong Won Yu, Ra-Yeong Song, Hyungju Kwon, and Kyu Eun Lee have no conflicts of interest or financial ties to disclose.

    Additional information

    Young Jun Chai and Hyunsuk Suh have contributed equally to this study as co-first authors.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Chai, Y.J., Suh, H., Woo, JW. et al. Surgical safety and oncological completeness of robotic thyroidectomy for thyroid carcinoma larger than 2 cm. Surg Endosc 31, 1235–1240 (2017). https://doi.org/10.1007/s00464-016-5097-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-016-5097-1

    Keywords

    Search

    Navigation