Robotic versus endoscopic transoral thyroidectomy in papillary thyroid cancer: A comparative analysis of surgical outcomes in 240 consecutive patients

Abstract

Background: This study compared the surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) in papillary thyroid cancer (PTC). Methods: The TOETVA and TORT groups comprised 119 and 121 patients between November 2016 and May 2022. Clinico-surgical outcomes and operation times were retrospectively reviewed. Results: The TORT group showed a higher number of retrieved central compartment lymph nodes, shorter hospital stays, and lower pain score after 48 h than the TOETVA group. No significant difference was observed in the other postoperative complications, including permanent vocal cord palsy. Total operation, working space creation, and endoscopic or robotic surgery times of the TORT group were longer than those of the TOETVA group.Conclusions: TORT and TOETVA are feasible and safe. TORT may have some advantages, such as central compartment node dissection, shorter hospital stays, and pain score after 48 h in PTC, despite a longer operative time.

Three‐port transoral robotic thyroidectomy without axillary incision: A preliminary report on a case series from Vietnam

“…This difference was shown in a study by Lee et al, comparing 121 TORT patients and 119 TOETVA patients, with 7.4 � 3.0 and 5.0 � 3.1 lymph nodes harvested, respectively, with a statistically significant difference (p = 0.001). 16 In our study of five patients, the average number of lymph nodes harvested was 4.2 (range 3-5), with one patient found to have positive central neck lymph node metastasis (pN1a) after surgery (accounting for 20%).…”

“…One of the advantages of the transoral approach is that it enables easy harvesting of central lymph nodes, especially with the assistance of the robotic surgery system, which can harvest more lymph nodes than endoscopic surgery. This difference was shown in a study by Lee et al., comparing 121 TORT patients and 119 TOETVA patients, with 7.4 ± 3.0 and 5.0 ± 3.1 lymph nodes harvested, respectively, with a statistically significant difference ( p = 0.001) 16 . In our study of five patients, the average number of lymph nodes harvested was 4.2 (range 3–5), with one patient found to have positive central neck lymph node metastasis (pN1a) after surgery (accounting for 20%).…”

“…When comparing 119 TOETVA patients and 121 TORT patients, Lee et al. found that the time for lobectomy in the TORT group was 173.4 ± 31.1 min, which was higher than the 138.8 ± 27.7 min in the TOETVA group, with a statistically significant difference ( p < 0.001) 16 . Another study, by Min et al., compared 43 TORT patients and 142 TOETVA patients and yielded similar results, with average operative times of 158.9 ± 36.6 min and 106.3 ± 30.1 min, respectively, and a statistically significant difference ( p < 0.001) 19 .…”

“…Another study of 173 TORT patients reported that ten patients had temporary recurrent laryngeal nerve damage (5.8%), and two patients had permanent damage (1.2%) 15 . Furthermore, when comparing TORT complications with those of TOETVA, Lee and colleagues found that the temporary hoarseness rate of TORT was 2.5% (3/121), which was significantly lower than the temporary hoarseness rate of TOETVA, which was 8.4% (10/119), with a statistically significant difference ( p = 0.049) 16 . In our study, no patients had temporary recurrent laryngeal nerve damage; this may be because we had the experience of approximately 500 TOETVA patients before implementing TORT, resulting in fewer complications.…”

Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis

“…We believe that the longer operative time, hospital stay, and increased drainage in the TOETVA group were due to the additional time required to detach flaps before the procedure. However, as operators gain more experience and higher-quality medical equipment is used, this time can be significantly reduced 31 …”