A Comparative Study of Two Robotic Thyroidectomy Procedures: Transoral Vestibular Versus Bilateral Axillary-Breast Approach

Abstract

Objective: To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomies (BABART).Methods: A total of 99 patients with papillary thyroid carcinoma without distant metastasis were enrolled in this study from May 2020 to April 2021. 99 patients had received an ultrasound guided fine needle aspiration prior to surgical intervention so the appropriate procedure can be planned. 49 patients underwent TOVRT, and another 50 patients underwent BABART. We performed TOVRT using three intraoral ports or adding the right axillary fold incision to enhance fine countertraction of tissue for radical oncological dissection. The clinical data such as age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were observed and analyzed. Results: There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (all P > 0.05). Lobectomy or total thyroidectomy with central lymph node dissection using two different robotic thyroidectomy approaches were performed in 99 cases. In all cases, we used intraoperative neuro-monitoring system and confirmed that all RLNs were preserved. All patients had papillary thyroid carcinomas (PTC)． Patients accepted TOVRT were younger than who accepted BABART and patients who accepted TOVRT had smaller primary tumor size. The TOVRT group had a longer surgical time than the BABART group, and was superior in postoperative drainage volume and cosmetic effect (visual analogue scale, VAS)(all P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (numerical rating scale, NRS) between the two groups (P > 0.05). However, there were some peculiar complications such as paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case) in transoral thyroidectomy. Conclusion: Transoral-vestibular robotic thyroidectomy is safe and feasible for selected patients, which is a potential alternative approach for patients who require no scarring of the neck.