Revisiting robotic approaches to endocrine neoplasia

Liu, Shirley Yuk‐Wah; Lang, Brian Hung‐Hin

doi:10.1097/cco.0000000000000245

Cited by 7 publications

(5 citation statements)

References 113 publications

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“…Recently, intraoperative nerve monitoring [ 38 – 41 ], a transoral approach [ 42 – 46 ], and robotic surgery [ 47 – 50 ] have emerged in endoscopic thyroid surgery. We believe that intraoperative nerve monitoring is efficient for identifying and preserving the recurrent nerve and external branch of the superior laryngeal nerve.…”

Section: Discussionmentioning

confidence: 99%

Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

Shimizu

Okamura

et al. 2019

Surg Today

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Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves' disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.

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Section: Discussionmentioning

confidence: 99%

Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

Shimizu

Okamura

et al. 2019

Surg Today

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“…Concerning the oncological safety, robotic procedures for thyroid cancers are controversial. [ 17 18 19 20 21 ] Papillary thyroid microcarcinoma has a very good prognosis. Some studies had reported that total thyroidectomy with prophylactic central lymph node dissection is necessary in patients with papillary thyroid microcarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma

Zhu

Zhuang

et al. 2016

Chinese Medical Journal

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Background:A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA), compared with conventional open procedure in papillary thyroid microcarcinoma.Methods:One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n = 50 in each group). The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale (VAS), postoperative hospital stay time, complications, and numerical scoring system (NSS, used to assess cosmetic effect) were analyzed.Results:The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs. 90.7 ± 10.3 min, P < 0.05). The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs. 3.8 ± 1.2, P < 0.05) and NSS (8.9 ± 0.8 vs. 4.8 ± 1.7, P < 0.05). The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant (all P > 0.05). Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group.Conclusions:Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.

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“…The risk of brachial plexus injury has since been reduced by placing the arm in a flexed 90-degree position (extended salute position), which reduces the traction on the nerve [56, 57]. Rare complications of tracheal and oesophageal injuries have been reported; however, the incidence is no higher than the conventional open approach [58].…”

Section: Robotic Transaxillary Thyroidectomymentioning

confidence: 99%

Extracervical Approaches to Thyroid Surgery: Evolution and Review

Sephton

2019

Minimally Invasive Surgery

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Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.

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Revisiting robotic approaches to endocrine neoplasia

Cited by 7 publications

References 113 publications

Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma

Extracervical Approaches to Thyroid Surgery: Evolution and Review

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