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The learning curve for single-port transaxillary robotic thyroidectomy (SP-TART): experience through initial 50 cases of lobectomy

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Abstract

The new da Vinci® single-port (SP) robotic system, which utilizes a smaller incision and work space compared to the previous versions, is suitable for thyroidectomy. This study aimed to evaluate the learning curve for SP transaxillary robotic thyroidectomy (SP-TART) in a single-center. Fifty consecutive patients who underwent SP-TART between October 2021 and April 2022 in Seoul St. Mary’s Hospital in Seoul, Korea, were included in this retrospective analysis. We examined the clinicopathological characteristics and short-term surgical outcomes and assessed the learning curve for SP-TART using cumulative summation analysis. The mean operation time was 57.8 ± 14.1 min, and the mean tumor size was 1.0 ± 0.7 (range, 0.3–3.7) cm. The patients were discharged approximately 2 days after surgery, and only two (4%) patients developed postoperative complications, including drainage-site bleeding and surgical site infection. Risk factors for long operation time were thyroiditis, amount of blood loss, and lymph node metastasis. The learning curve for SP-TART was 20 cases for the experienced robotic surgeon. SP-TART is technically feasible and safe with a short incision length and short operation time. It is a valuable alternative operative option with good surgical outcomes and outstanding cosmetic results.

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References

  1. Chang EHE, Kim HY, Koh YW, Chung WY (2017) Overview of robotic thyroidectomy. Gland Surg 6:218

    Article  PubMed  PubMed Central  Google Scholar 

  2. Duncan TD, Rashid Q, Speights F, Ejeh I (2009) Transaxillary endoscopic thyroidectomy: an alternative to traditional open thyroidectomy. J Natl Med Assoc 101:783–787

    PubMed  Google Scholar 

  3. Lee J, Chung WY (2013) Robotic surgery for thyroid disease. Eur Thyroid J 2:93–101

    PubMed  PubMed Central  Google Scholar 

  4. Tae K, Ji YB, Song CM, Ryu J (2019) Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol 12:1

    Article  PubMed  Google Scholar 

  5. Townsend CM, Beauchamp RD, Evers BM, Mattox KL (2021) Sabiston textbook of surgery. Elsevier Health Sciences, New York

    Google Scholar 

  6. Foley CS, Agcaoglu O, Siperstein AE, Berber E (2012) Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc 26:2259–2266

    Article  PubMed  Google Scholar 

  7. Lee J, Chung WY (2013) Robotic thyroidectomy and neck dissection: past, present, and future. Cancer J 19:151–161

    Article  PubMed  Google Scholar 

  8. Tae K, Ji YB, Jeong JH, Lee SH, Jeong M, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228

    Article  PubMed  Google Scholar 

  9. Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214:558–564

    Article  PubMed  Google Scholar 

  10. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg 41:791

    CAS  Google Scholar 

  11. Chai YJ, Chae S, Oh MY, Kwon H, Park WS (2021) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): surgical outcomes and learning curve. J Clin Med 10:863

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lee KE, Choi JY, Youn Y-K (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:230–236

    Article  PubMed  Google Scholar 

  13. Lee DY, Baek S-K, Jung K-Y (2016) Endoscopic thyroidectomy: retroauricular approach. Gland Surg 5:327

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. J Brit Surg 83:875

    Article  CAS  Google Scholar 

  15. Pan J-H, Zhou H, Zhao X-X, Ding H, Wei L, Qin L et al (2017) Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 31:3985–4001

    Article  PubMed  Google Scholar 

  16. Son SK, Kim JH, Bae JS, Lee SH (2015) Surgical safety and oncologic effectiveness in robotic versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis. Ann Surg Oncol 22:3022–3032

    Article  PubMed  Google Scholar 

  17. Wang Y, Liu K, Xiong J, Zhu J (2015) Robotic thyroidectomy versus conventional open thyroidectomy for differentiated thyroid cancer: meta-analysis. J Laryngol Otol 129:558–567

    Article  PubMed  Google Scholar 

  18. Kang S-W, Jeong JJ, Nam K-H, 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

    Article  PubMed  Google Scholar 

  19. Kang S-W, Jeong JJ, Yun J-S, Sung TY, Lee SC, Lee YS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406

    Article  PubMed  Google Scholar 

  20. Kim K, Kang S-W, Kim JK, Lee CR, Lee J, Jeong JJ et al (2020) Robotic transaxillary hemithyroidectomy using the da Vinci SP robotic system: initial experience with 10 consecutive cases. Surg Innov 27:256–264

    Article  PubMed  Google Scholar 

  21. Wiltshire JJ, Drake TM, Uttley L, Balasubramanian SP (2016) Systematic review of trends in the incidence rates of thyroid cancer. Thyroid 26:1541–1552

    Article  PubMed  Google Scholar 

  22. Jang J, Yoo D-S, Chun BC (2021) Spatial distribution and determinants of thyroid cancer incidence from 1999 to 2013 in Korea. Sci Rep 11:1–8

    Article  Google Scholar 

  23. Hong S, Won Y-J, Park YR, Jung K-W, Kong H-J, Lee ES (2020) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2017. Cancer Res Treat Off J Korean Cancer Assoc 52:335

    Google Scholar 

  24. LeClair K, Bell KJ, Furuya-Kanamori L, Doi SA, Francis DO, Davies L (2021) Evaluation of gender inequity in thyroid cancer diagnosis: differences by sex in US thyroid cancer incidence compared with a meta-analysis of subclinical thyroid cancer rates at autopsy. JAMA Internal Med 181:1351–1358

    Article  Google Scholar 

  25. Choi Y, Lee JH, Kim YH, Lee YS, Chang H-S, Park CS et al (2014) Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 26:693–699

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bhatia P, Mohamed HE, Kadi A, Kandil E, Walvekar RR (2015) Remote access thyroid surgery. Gland Surg 4:376

    PubMed  PubMed Central  Google Scholar 

  27. Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877

    Article  PubMed  Google Scholar 

  28. Lee J, Nah KY, Kim RM, Ahn YH, Soh E-Y, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194

    Article  PubMed  Google Scholar 

  29. Yoo JY, Chae YJ, Cho HB, Park KH, Kim JS, Lee SY (2013) Comparison of the incidence of postoperative nausea and vomiting between women undergoing open or robot-assisted thyroidectomy. Surg Endosc 27:1321–1325

    Article  PubMed  Google Scholar 

  30. Lirici M, Hüscher C, Chiodini S, Napolitano CA, Recher M (1997) Endoscopic right thyroid lobectomy. Surg Endosc 8:877

    Article  Google Scholar 

  31. Lee J, Lee J, Nah K, Soh E, Chung W (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446

    Article  CAS  PubMed  Google Scholar 

  32. Cadière M, Himpens M, Germay O, Izizaw R, Degueldre M, Vandromme M et al (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467–1477

    Article  PubMed  Google Scholar 

  33. Liu S, Kelley S, Behm K (2021) Single-port robotic transanal minimally invasive surgery (SPR-TAMIS) approach to local excision of rectal tumors. Tech Coloproctol 25:229–234

    Article  CAS  PubMed  Google Scholar 

  34. Kim WW, Jung JH, Park HY (2015) The learning curve for robotic thyroidectomy using a bilateral axillo-breast approach from the 100 cases. Surg Laparosc Endosc Percutan Tech 25:412–416

    Article  PubMed  Google Scholar 

  35. Chen Y-H, Kim H-Y, Anuwong A, Huang T-S, Duh Q-Y (2021) Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes. Surg Endosc 35:6179–6189

    Article  PubMed  Google Scholar 

  36. Lee J, Yun JH, Choi UJ, Kang S-W, 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 2012:1–9

    Article  Google Scholar 

  37. Kwak HY, Kim SH, Chae BJ, Song BJ, Jung SS, Bae JS (2014) Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: CUSUM analysis of a single surgeon’s experience. Int J Surg 12:1273–1277

    Article  PubMed  Google Scholar 

  38. Sivaprakasam J, Purva M (2010) CUSUM analysis to assess competence: what failure rate is acceptable? Clin Teach 7:257–261

    Article  PubMed  Google Scholar 

  39. Wang M, Meng L, Cai Y, Li Y, Wang X, Zhang Z et al (2016) Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg 20:924–935

    Article  PubMed  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh E-Y (2011) Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc 25:906–912

    Article  PubMed  Google Scholar 

  42. Lee J, Chung WY (2012) Current status of robotic thyroidectomy and neck dissection using a gasless transaxillary approach. Curr Opin Oncol 24:7–15

    Article  PubMed  Google Scholar 

  43. Kang S-W, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam K-H et al (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148:1214–1221

    Article  PubMed  Google Scholar 

  44. Shindo M, Chheda NN (2007) Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Archiv Otolaryngol Head Neck Surg 133:481–485

    Article  Google Scholar 

  45. Christou N, Mathonnet M (2013) Complications after total thyroidectomy. J Visc Surg 150:249–256

    Article  CAS  PubMed  Google Scholar 

  46. Sutton P, Awad S, Perkins A, Lobo D (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel™ and the Ligasure™. J Brit Surg 97:428–433

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank all the nurses who participated in the surgery and contributed to this study.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea

    Joonseon Park, ll Ku Kang, Kwangsoon Kim, Ja Seong Bae & Jeong Soo Kim

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  1. Joonseon Park
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  3. Kwangsoon Kim
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Correspondence to Kwangsoon Kim.

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Conflict of interest

The authors have no source of funding and no conflict of interest to declare.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Seoul St. Mary’s Hospital, The Catholic University of Korea (IRB No: KC22RISI0123 and date of approval: 2022.05.23).

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Patient consent was waived due to the retrospective nature of this study.

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Data is available.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later versions.

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Park, J., Kang, l.K., Kim, K. et al. The learning curve for single-port transaxillary robotic thyroidectomy (SP-TART): experience through initial 50 cases of lobectomy. Updates Surg 75, 691–700 (2023). https://doi.org/10.1007/s13304-022-01445-9

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