Robotic Total Thyroidectomy with Modified Radical Neck Dissection via Unilateral Retroauricular Approach

Abstract

For all of the patients, robotic total thyroidectomy with MRND (levels II, III, IV, V) via unilateral RA approach was successfully completed without any significant intraoperative complications or conversion to open or other approach methods. The total operation time was defined as the time from initial skin incision to removal of the final specimen, which was an average 306.1 ± 11.1 min (Table 2). This included the time for skin flap elevation and neck dissection under gross vision (87 ± 2.8 min), setting up the robotic system for RAND (6.8 ± 2.4 min), console time using the robotic system for RAND (59.3 ± 2.2 min), flap elevation for thyroidectomy (11.3 ± 2.5 min), robotic arms docking for ipsilateral thyroidectomy (6.3 ± 2.5 min), console time for ipsilateral thyroidectomy (61.3 ± 2.1 min), robotic arms docking for contralateral thyroidectomy (6.3 ± 2.5 min), and console time for contralateral thyroidectomy (61.8 ± 2.1 min). The working space created from RA incision was sufficient, and manipulations of the robotic instruments through this approach were technically feasible and safe without any mutual collisions throughout the entire operation. It also allowed for an excellent magnified surgical view enabling visualization of important local anatomical structures. There was no postoperative vocal cord palsy due to recurrent laryngeal nerve injury. However, two patients developed transient hypoparathyroidism, which resolved in the end without the need for calcium or vitamin D supplementation after certain period of medical management (Table 3). Also, there was no incidence of postoperative hemorrhage or hematoma formation, although a single patient developed a postoperative seroma on postoperative day 9, which was managed conservatively without the need for further surgical intervention. On average, the wound catheter was removed 6.8 ± 1 days after surgery and the patient was discharged from the hospital at an average 11 ± 2.8 days from admission (Table 1). Final surgical pathology confirmed the diagnosis of papillary carcinoma for every patient. The total number of cervical nodes retrieved from CCND and MRND was 9.8 ± 4 and 33.1 ± 11 respectively, and the number of positive metastatic nodes was 3 ± 1.4 and 7.3 ± 1.7 respectively (Table 1). In three patients (patients 2, 3, and 4), the presence of one parathyroid gland was each verified in the pathology specimen. All four patients have received high-dose (150 mCi) radioiodine ablation (RAI) therapy after the operation and are being followed up (average 11.3 months, range 9-13 months) on a regular basis with no evidence of recurrence (post-RAI, most recent, nonsuppressed thyroglobulin range 0.1-0.4 ng/ml, antithyroglobulin antibody range 13.7-147.5 IU/ml). (ABSTRACT TRUNCATED)

Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system

“…The specific surgical procedure of robotic RA thyroidectomy with the former Si system (Intuitive Surgical) has been described elsewhere . Based on preoperative imagings, HT was conducted in benign thyroid lesions or solitary thyroid carcinomas less than 4 cm, and TT was executed in multiple thyroid carcinomas, tumors larger than 4 cm, or with positive lymph node metastasis.…”

“…Robotic retroauricular (RA) thyroidectomy, one of the most recently spotlighted remote access surgical techniques of thyroidectomy, has been developed and actively practiced by several robotic surgeons to overcome certain limitations of the former robotic transaxillary (TA) thyroidectomy. There have been successful reports of the robotic RA thyroidectomy by many institutions worldwide, and we also have previously reported our own successful surgical experiences of this technique . Hemithyroidectomy (HT), total thyroidectomy (TT), and TT with simultaneous robot‐assisted modified radical neck dissection (RAND) were all feasible through the single RA port …”

Robot-Assisted Retroauricular Neck Surgery in Head and Neck Cancers

“…The application of RRAND has been reported in patients with differentiated thyroid cancers [8][9][10][11] laryngopharyngeal cancers [6][7][8], salivary gland tumors [8,[11][12][13] oral cavity cancers [8,[14][15][16] and nasopharyngeal carcinomas [12]. In these patients, neck dissection is planned according to the primary tumor.…”

Effect of training frequency on the learning curve on the da Vinci Skills Simulator

“…Here, robotic‐assisted procedures are still in their investigatory phase . Further possible uses for robotic surgery are in thyroidectomy and obstructive sleep apnea hypopnea syndrome surgery . Single case reports can be found for robotic surgery of nasopharyngeal and recurrent nasopharyngeal carcinoma …”

“…11,12 Further possible uses for robotic surgery are in thyroidectomy and obstructive sleep apnea hypopnea syndrome surgery. 13,14 Single case reports can be found for robotic surgery of nasopharyngeal and recurrent nasopharyngeal carcinoma. 15,16 The complex da Vinci Surgical System consists of several key elements: a high definition 3D-vision system, a patient side cart where the patient is located during the surgery, the Si console where the surgeon sits while operating, and the EndoWrist instruments.…”