Robotic Thyroid Surgery

Abstract

While thyroid surgery has been performed safely for nearly a century, the societal desire for a smaller and less visible surgical incision and consequent neck wound have become increasingly important for some patients. Within the last 5 years, thyroid surgical methods have been adapted by several groups to utilize robotic platform technology with the goal of achieving safe resection of the thyroid gland without a visible neck blemish. We review the currently published data regarding the use of surgical robotic platforms to perform remote access thyroid surgery. In particular, the currently described approaches, outcomes, complication profile, learning curve, and cost are examined. We also discuss the utility of the approach in populations of special interest to the endocrine surgeon, and a rational framework for adoption of the technology among surgeons interested in adding this technique to their armamentarium.

Thyroid Nodules with Benign Cytology: Is Size ≥4 cm an Indication for Surgery?

“…Second, in these cases (non‐autonomous nodules ≥4 cm), consensus exists regarding the indication for thyroidectomy if cytology is suspicious of malignancy, malignant, indeterminate, or non‐diagnostic [2]. Therefore, considering these aspects (systematic indication for FNA and surgery when the cytology result is not benign), the results of that series [1] are in accordance with current recommendations [2].…”

“…We showed that only 3 of 84 nodules ≥4 cm with benign cytology were malignant [4]. The results of these studies, the only ones reporting the evolution of all patients with large nodules with benign cytology and not only that of a subgroup submitted to surgery [3, 4], do not support the proposal that every nodule ≥4 cm should be removed [1].…”

“…Recently, Wharry et al [1] reported the malignancy rate for 382 thyroid nodules. First, except for purely cystic or autonomous nodules, fine‐needle aspiration (FNA) is recommended for nodules ≥4 cm, irrespective of clinical history and ultrasonographic features [2].…”

“…One limitation of the study of Wharry et al [1] is that the rate of malignancy was extracted from a subgroup of patients referred for thyroidectomy. It is reasonable to assume that this subgroup had characteristics of a higher risk for malignancy than the subgroup in which the clinicians decided to use observation.…”

“…It would therefore be necessary to evaluate all cases in order to define the true frequency of malignancy in nodules ≥4 cm with benign cytology. Analyzing the series of Table 5 in the article of Wharry et al [1], the malignancy rates were also extracted from a subgroup of patients referred for surgery, except for two studies [3, 4]. In the first study, Porterfield et al [3] reported the evolution of 742 patients with nodules ≥3 cm with benign cytology: (i) of 145 nodules submitted to surgery, only one was malignant, and (ii) none of the more than 500 patients not submitted to thyroidectomy developed apparent malignancy after 3 years of follow‐up.…”