A single surgeon's experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach

Kim, Wan Wook; Jung, Jin Hyang; Park, Ho Yong

doi:10.1002/jso.23793

Cited by 53 publications

(76 citation statements)

References 16 publications

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“…As demonstrated in a study analyzing the learning curve of BABA RT in 100 cases by a single surgeon, the mean operative time decreased significantly from 232.6 minutes in the first 40 cases to 188.9 minutes in the next 60 cases (P=0.001) (13). In another study by Kim et al on 300 cases by a single surgeon, the operative time also reduced remarkably after 35-40 cases of BABA RT (31). The learning curve of BABA RT was therefore about 40 cases.…”

Section: Learning Curvementioning

confidence: 91%

“…Similar to other minimally invasive procedures, the operative time of BABA procedures is expected to decrease with increasing experiences of surgeons and the operating team (31). As demonstrated in a study analyzing the learning curve of BABA RT in 100 cases by a single surgeon, the mean operative time decreased significantly from 232.6 minutes in the first 40 cases to 188.9 minutes in the next 60 cases (P=0.001) (13).…”

Section: Learning Curvementioning

confidence: 99%

“…In the literature, there are 11 studies comparing the outcomes between BABA RT and OT ( Table 1) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). All except one study are originated from South Korea which represents the major and leading body of worldwide experiences and evidences (27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Section: Comparison With Conventional Otmentioning

confidence: 99%

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Bilateral axillo-breast approach robotic thyroidectomy: review of evidences

Liu

Kim

2017

Gland Surg.

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Abstract:The bilateral axillo-breast approach (BABA) is one of the most popular contemporary remoteaccess thyroidectomy techniques. While the initial experiences with BABA endoscopic thyroidectomy (ET)were associated with some technical challenges and safety concerns, many limitations of the technique could now be substantially overcome by BABA robotic thyroidectomy (RT). In this review, the current literature evidences of BABA RT were analyzed. Data regarding the patient selection, the learning curve, and the comparison with open thyroidectomy (OT) and BABA ET were examined. Careful case selection for BABA RT should be undertaken according to factors related to the patient and the thyroid pathology.The learning curve of BABA RT was about 40 cases. Comparing to OT, BABA RT was comparable to OT for the complication profiles and most perioperative outcomes. But it was associated with longer operative time, higher cost and possibly inferior oncological control with lower number of central lymph node (LN) retrieved. When compared to BABA ET, BABA RT was comparable for most perioperative outcomes except longer operative time and higher cost. Yet, BABA RT was superior to BABA ET for better oncological control. BABA RT is a safe and effective procedure for most benign thyroid conditions and low-risk differentiated thyroid cancers (DTC).

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Section: Learning Curvementioning

confidence: 91%

Section: Learning Curvementioning

confidence: 99%

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Bilateral axillo-breast approach robotic thyroidectomy: review of evidences

Liu

Kim

2017

Gland Surg.

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“…The number of retrieved LNs was 7.8±3.0 in the operations using FI, which was higher than the 6.7±0.2 reported in previous 300 surgeries without FI. 3 In addition to identifying the LNs, FI was helpful to distinguish LN from the parathyroid gland, because the parathyroid gland does not show ICG uptake like LNs. In some cases, we could not only identify the ipsilateral LNs but also the contralateral LNs.…”

Section: Resultsmentioning

confidence: 99%

Early Experience and the Feasibility of the Firefly Technology for Central Lymph Node Dissection (CLND) in Robotic Thyroidectomy Using the BABA

Choi

Lee

Jung

et al. 2017

J Minim Invasive Surg

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In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.8±3.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.

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“…For example, early reports on the North American experience with axillary approaches introduced risks of carotid and esophageal injury that was almost unheard of with traditional thyroid surgery. Such risks greatly repressed early North American enthusiasm based on remote access experiences of international authors (14,17). (II) In addition to these risks, some reports of transoral surgery through the floor of mouth resulted in unacceptably high rates of permanent recurrent laryngeal nerve paralysis (18).…”

Section: Different Access Approachesmentioning

confidence: 99%