Comparison of surgical outcomes between endoscopic and robotic thyroidectomy

Yoo, Ho; Chae, Byung Joo; Park, Hyung Seok; Kim, Ki Ho; Kim, Shin Hyuk; Song, Byung Joo; Jung, Sang Seol; Bae, Ja Seong

doi:10.1002/jso.22106

Cited by 63 publications

(80 citation statements)

References 16 publications

(23 reference statements)

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“…Postoperative thyroglobulin levels for the 3 cases of papillary cancer were below the recommended limit of 10 ng/ml, suggestive of a good outcome following thyroidectomy [31]. The literature also shows that the robotic technique has been utilized in the management of follicular [11,15,32], medullary [33] and microcapillary [20,34] carcinoma (online suppl. table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Extrathyroidal involvement [12,14,15,20,26,27,29,30,31,32,33], multiple lateral lymph node involvement [12,14,15,27,28,29,30,34], perinodal involvement at metastatic lymph nodes [12,14,15,20,27,28,29,30,34] and distant metastatic disease [12,14,26,27,28,29,30,31,32,33] have all been cited as exclusion criteria for studies (online suppl. table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Patient characteristics have been used as exclusion criteria for this procedure in both benign and malignant disease include thyroiditis, as both a definite and relative contraindication [32,33], severe [12,14,15,27,29] or advanced Graves' disease [16,26] and a history of neck surgery [12,14,15,16,26,27,29]. Graves' disease, however, has since been shown to be a valid indication for the technique [23].…”

Section: Discussionmentioning

confidence: 99%

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Indications for the Gasless Transaxillary Robotic Approach to Thyroid Surgery: Experience of Forty-Seven Procedures at the American Hospital of Paris

Aïdan¹,

Pickburn²,

Monpeyssen³

et al. 2013

Eur Thyroid J

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Background: Thyroid surgery is in a state of evolution from traditional open approaches to novel robotic techniques. The gasless transaxillary approach to thyroid surgery is effective in the management of thyroid cancer, and complications after robotic thyroidectomy are no higher than experienced after open or endoscopic techniques. The transaxillary robotic approach also avoids an anterior neck scar. This paper presents what the authors believe to be the largest cohort of patients reported in Europe undergoing gasless transaxillary robotic thyroid surgery, with the aim of defining the indications for this procedure. Methods: Forty-six patients underwent robotic thyroid surgery via the transaxillary approach and were enrolled in this study between March 2010 and September 2012. All patients were operated on by one surgeon at one clinical center. Reviewed data included patient characteristics, pathological characteristics, extent of surgery and postoperative complications. The mean follow-up time was 7.29 months. Results: Forty-six patients underwent 47 procedures, the average age of the patients was 43 years and the male to female ratio was 1:22. Undertaken were 30 lobectomies, 3 subtotal thyroidectomies, 13 total thyroidectomies and 1 totalization. One case was converted to an open procedure. The ratio of malignant to benign disease was 1:6.67 (6:40 cases) and analysis of the surgical specimens showed 6 follicular lesions, 24 follicular adenomas, 3 colloid lesions, 1 case of thyroiditis/lymphatic lesion, 3 adenomatoid lesions, 3 oncocytic adenomas, 3 papillary cancers and 3 microcapillary cancers. The overall average size of an individual specimen removed was 45.40 ± 28.95 cm³ (range 5-160, n = 47) and the average largest diameter of the lesion removed was 3.72 ± 0.95 cm (range 1.4-6.0, n = 47). Postoperatively, there were 5 recurrent laryngeal nerve injuries (4 transient), 2 transient brachial plexopathies, 1 case of postoperative dysphagia and 1 of collection of blood at the site of surgery. There were no cases of disease recurrence at follow-up. Conclusions: The gasless robotic transaxillary approach to thyroid surgery has been predicted to become a standard technique. It has been shown to be efficacious in the management of thyroid cancer with lateral neck metastases; however, more data relating to oncological safety in long-term follow-up is required. This intervention is also appropriate for benign thyroid disease including Graves' disease. To achieve consistently successful results, careful patient selection is fundamental in terms of patient characteristics and the anatomical aspects of the lesion. This is especially important with a geographical expansion to include North America and Europe. The excellent cosmetic results of this procedure make it ideal for patients who have esthetic concerns regarding particular difficulties with healing; however, in common with all new surgical procedures, further evidence must be sought to confirm its indications over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Indications for the Gasless Transaxillary Robotic Approach to Thyroid Surgery: Experience of Forty-Seven Procedures at the American Hospital of Paris

Aïdan¹,

Pickburn²,

Monpeyssen³

et al. 2013

Eur Thyroid J

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“…It was first described by Ikeda et al in 2000 [23]. To our knowledge, over 1,500 patients have undergone this approach [24][25][26][27][28][29][30][31][32][33][34]. The patient is put under general anesthesia and lies in a supine position.…”

Section: Extra-cervical/indirect Approachesmentioning

confidence: 99%

“…The cost is not just limited to the initial installment of the da Vinci Robotic system, but also includes the expensive consumables, ongoing maintenance, and training of staff. The average operation cost is nearly eight times more than the conventional approach (US$ 6,655 vs. 829, p \ 0.01) [26,66]. Therefore, routine use of the robotic-assisted approach might not be justified in the economic sense.…”

Section: Robotic-assisted Thyroidectomymentioning

confidence: 99%

Endoscopic Thyroidectomy: A Literature Review and Update

Wong

Lang

2012

Curr Surg Rep

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Since the first report of endoscopic subtotal parathyroidectomy in 1996, a variety of endoscopic surgical approaches has been reported. These endoscopic approaches include the minimally-invasive video-assisted thyroidectomy (MIVAT), the endoscopic lateral approach, the lateral mini-incision approach, the anterior/chest (hybrid) approach, the transaxillary approach, the axillobreast approach, the post-auricular and axillary approach, and other novel experimental approaches. Some of these approaches could be done with the assistance of the da Vinci robot (i.e. robotic-assisted thyroidectomy). For simplification, these approaches could be categorized into the cervical/direct approach and the extra-cervical/indirect approach. Each technique or approach has its own benefits and weaknesses. Currently, there is no preferred approach in the literature and the choice seems to be determined by the surgeon's own experience and the patient's preference. In our experience, the transaxillary approach was a technically more challenging procedure and was associated with longer hospital stay, longer operating time, more immediate pain, and increased overall RLN injury and morbidity than MIVAT. The 6-month scar appearance and patient satisfaction were similar between the two procedures.

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