Abstract:Background Thyroidectomy transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe and cosmetically appealing alternative for well-selected patients undergoing thyroidectomy. However, during TOETVA, placement of the two lateral trocars and/or manipulation of the surgical instruments through the trocars may potentially injure and/or compress the mental nerve (MN) because the actual location of the nerve foramen may vary among individuals. The MN injury rate was reported to be as high as 75% in t… Show more
“…Other robot-related complications, such as lacerated mouth injuries, facial contusions on the cheekbones, and perforated skin on the chin need to be noted as well. However, these complications are closely related to the operator’s experience and can generally be avoided with appropriate protection and careful procedures [ 20 – 22 ]. Fig.…”
Objective
To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART).
Methods
A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including 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 recorded and analyzed.
Results
There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case).
Conclusion
Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.
“…Other robot-related complications, such as lacerated mouth injuries, facial contusions on the cheekbones, and perforated skin on the chin need to be noted as well. However, these complications are closely related to the operator’s experience and can generally be avoided with appropriate protection and careful procedures [ 20 – 22 ]. Fig.…”
Objective
To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART).
Methods
A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including 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 recorded and analyzed.
Results
There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case).
Conclusion
Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.
“…Other robot-related complications, such as lacerated mouth injuries, facial contusions on the cheekbones, and perforated skin on the chin, have also been reported. However, these complications are closely related to the operator's experience and can generally be avoided with appropriate protection and careful procedures [20][21][22].…”
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.
“… 22 Instead, printing out a 3D model based on 3D reconstructed CT images can provide a real object to a surgeon even though the printing process is time-consuming and may cost. 2 , 23 By appreciating a real model, the operator has real tactile feedback and gets better control of the important structures of the patient. For example, the surgeon can do simulating surgery on a 3D printing facial bone fracture model by direct cutting, drilling, and reduction for surgery rehearsal.…”
Background:
To surgically remove osteoma and to keep an optimal cosmetic profile would be very challenging. To solve the difficulty, we utilized the three-dimensional (3D) printing technologies in generating a patient-specific instrument guide (PSIG) for the safe removal of a skull bone tumor.
Methods:
The preoperational brain computed tomography (CT) provided the digital imaging with thin slices, and then images were reconstructed into a 3D skull model. Based on the model, we designed a PSIG to make landmarks on the osteoma to avoid excessive removal of the skull bone. During the operation, the surgeons could remove the osteoma piece by piece by using the landmark as a reference point.
Results:
The PSIG was successfully applied to remove an osteoma that measured 60 × 48 × 40 mm
3
over the left frontoparietal skull of a female patient. The 3D CT reconstruction taken both before and 4 months after surgery showed a significant change in the appearance of the osteoma.
Conclusion:
The PSIG was able to guide the surgeon in the safe removal of the skull osteoma, as well as in maintaining the cosmetic skull profile.
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