Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients

Abstract

Objectives/Hypothesis: Obesity is an increasing health concern worldwide. It has been associated with perioperative complications that could affect patient outcomes. Our aim was to compare surgical outcomes in obese and nonobese patients after transoral robotic thyroid (TORT) surgery.Study Design: Retrospective cohort study.Methods: A total of 304 consecutive patients who underwent TORT between January 2012 to December 2017 were included in the study. Patients were divided into two groups according to their body mass index (BMI): BMI < 30 kg/m 2 and BMI ≥ 30 kg/m 2 . Patient demographics, operative extent, pathological data, surgical outcomes, and postoperative complications were included and analyzed. A χ 2 test was used to compare categorical variables, and a Student t test was used to compare changes of continuous variables between groups. Statistical significance was conferred by a two-tailed P value of ≤.05.Results: There were 290 patients in the non-obese group and 14 patients in the obese group. There was no statistically significant difference between the two groups in terms of patient demographics, operative procedure, or pathological characteristics. The only statistically significant difference was for lymph node dissection (P = .012); however, for both groups, unilateral central node dissection was the most common procedure. There was also no statistically significant difference found for operative time, length of stay, pain score, or postoperative complications including TORT-specific complications such as oral commissure tear and general complications such as recurrent nerve injury.Conclusions: This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery.

A comparative study of two robotic thyroidectomy procedures: transoral vestibular versus bilateral axillary-breast approach

“…After the superior thyroid artery and vein ligated with ultrasonic energy device and the upper pole of thyroid lifted up, it’s very easy to identify the RLN with IONM, since the location of RLN insertion to the larynx is relatively fixed. Transoral-vestibular thyroidectomy has only been performed in South Korea, with a clinical study of 304 patients at most, and few in China, but the surgical outcome is uncertain [ 19 ]. From the experience of endoscopic surgery for the protection of recurrent laryngeal nerve and parathyroid gland, no serious complications occurred in transoral-vestibular robotic thyroid surgery.…”

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

“…Besides, it provides excellent view and exposure of the central compartment of the neck by the transoral approach to complete central neck dissection which obviously shorten surgeon's learning curve. Therefore, transoralvestibular thyroidectomy has only been performed in South Korea, with a clinical study of 304 patients at most, but few in China, and the surgical outcome is uncertain [19]. With the experience of endoscopic surgery for the protection of recurrent laryngeal nerve and parathyroid gland, no serious complications occurred in transoral-vestibular robotic thyroid surgery.…”

Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

“…Other remote access techniques include the retroauricular approach, trans-axillary technique, and bilateral axillo-breast approach ( 13 – 16 ). To date, none of these other approaches have become common in the West, while TOETVA is becoming relatively popular due to broad operative indications, wide eligibility and applicability for patients with benign or malignant disease, and even with a BMI greater than 30 ( 17 – 19 ). Although TOETVA has longer operative time when compared to the conventional open technique, patient satisfaction and cosmesis are superior with TOETVA ( 20 , 21 ).…”