Comparison of Endoscopic and Robotic Thyroidectomy

Abstract

Background. Endoscopic thyroidectomy is a technically challenging procedure. Robot-assisted thyroidectomy has been recently introduced and offers improved visualization and dexterity. The present study compared conventional endoscopic and robotic thyroidectomy for thyroid cancer patients in terms of perioperative outcomes and learning curve. All operations were performed by the same surgeon. Materials and Methods. Between April 2007 and March 2010, 96 patients underwent endoscopic thyroidectomy (endoscopy group) and 163 patients underwent robotic thyroidectomy (robot group). A gasless transaxillary approach was used in both groups. The 2 groups were compared in terms of patient characteristics, perioperative clinical results, complications, and pathologic details. Learning curves for the 2 procedures were compared based on the number of cases required to reach a consistent operation time. Results. Patient characteristics were similar for both groups. The mean total operation time for thyroidectomy with central compartment neck dissection was 142.7 ± 52.1 min in the endoscopy group and 110.1 ± 50.7 min in the robot group (P = .041). Both patient groups were similar in terms of pathological features including TNM stage, intraoperative blood loss, length of hospital stay, and complication rate. However, the mean number of retrieved central lymph nodes was 2.4 ± 1.9 for the endoscopy group and 4.5 ± 1.5 for the robot group (P = .004). The learning curve was 55-60 cases for endoscopic thyroidectomy and 35-40 cases for robotic thyroidectomy. Conclusion. Robotic thyroidectomy was found to be superior to endoscopic thyroidectomy in terms of operation time, lymph node retrieval, and learning curve. Complication rates and postoperative hospital stay were similar for the 2 procedures.Endoscopic approaches for thyroid cancer surgery can reduce scarring and postoperative neck discomfort without compromising oncologic effectiveness.

Robotic Surgery for Thyroid Disease

“…Among the quality-of-life benefits of robotic surgery are excellent cosmetic results, and reductions in neck sensory changes, voice, and swallowing discomfort after surgery. For surgeons, robotic surgery has improved ergonomics and has a shorter learning curve than open or endoscopic surgery [16,17,18]. …”

Robotic thyroidectomy and cervical neck dissection for thyroid cancer

“…However, in some studies, including our previous study, the absolute number of retrieved LNs was lower in patients undergoing robotic thyroidectomy (31,39). Additionally, studies that compared robotic thyroidectomy and endoscopic thyroidectomy groups reported higher numbers of retrieved LNs in the robotic thyroidectomy groups (14,15) (Table 1).…”

“…In most studies, the numbers of retrieved central LNs and stimulated TG levels in the robotic thyroidectomy group were comparable to those in the open thyroidectomy group without sacrificing the surgical safety parameters such as hypoparathyroidism and RLN injury rates (14,15,18,19,28,37,38). However, in some studies, including our previous study, the absolute number of retrieved LNs was lower in patients undergoing robotic thyroidectomy (31,39).…”

“…However, these endoscopic methods are technically challenging and require a long learning curve (12,13). Furthermore, cervical LN dissection, a standard procedure in the context of thyroid cancer surgery, is difficult to perform endoscopically (14)(15)(16).…”

Endoscopic Thyroidectomy: A Literature Review and Update

“…Since the first report of robotic trans-axillary thyroidectomy in 2009, robotic thyroidectomy has been widely performed worldwide [56][57][58][59]. Theoretically, it overcomes many of the technical challenges associated with transaxillary thyroidectomy because the robot can provide a threedimensional magnified view, seven degree of freedom and 90 articulation and can filter any hand tremors [56].…”