Robotic versus Open Thyroidectomy for Differentiated Thyroid Cancer: An Evidence-Based Review

Abstract

While open thyroidectomy (OT) is advocated as the gold standard treatment for differentiated thyroid cancer, the contemporary use of robotic thyroidectomy (RT) is often controversial. Although RT combines the unique benefits of the surgical robot and remote access thyroidectomy, its applicability on cancer patients is challenged by the questionable oncological benefits and safety. This review aims to analyze the current literature evidence in comparing RT to OT on thyroid cancers for their perioperative and oncological outcomes. To date, no randomized controlled trial is available in comparing RT to OT. All published studies are nonrandomized or retrospective comparisons. Current data suggests that RT compares less favorably than OT for longer operative time, higher cost, and possibly inferior oncological control with lower number of central lymph nodes retrieved. In terms of morbidity, quality of life outcomes, and short-term recurrence rates, RT and OT are comparable. While conventional OT continues to be appropriate for most thyroid cancers, RT should better be continued by expert surgeons on selected patients who have low-risk thyroid cancers and have high expectations on cosmetic outcomes. Future research should embark on prospective randomized studies for unbiased comparisons. Long-term follow-up studies are also needed to evaluate outcomes on recurrence and survival.

Bilateral axillo-breast approach robotic thyroidectomy: review of evidences

“…While the outcomes of RT and OT have been extensively compared in the literature (15)(16)(17)(18)(19)(20)(21)(22)(23)(24), none of the reports provides specific focus on BABA RT. In this review, we analyzed the current literature evidences about BABA RT, including its patient selection, the learning curve, and the comparison data with conventional OT and BABA ET.…”

“…Because BABA RT is not technically feasible on every patient, patients should be carefully selected according to the patient factors and the thyroid pathology (4,15). For patient related factors, there is no age limit for BABA RT but most surgeons apply the procedure on patients below 70 years of age (10,12).…”

Successful Treatment of Differentiated Thyroid Carcinoma with Transaxillary Robotic Surgery and Radioiodine: The First European Experience

“…Many systematic reviews and meta-analyses have been published regarding the safety and efficiency of robotic thyroidectomy. Those reviews relied mainly on Korean publications [13-15] showing that robotic thyroidectomy was as safe as OpenT for benign and cancer cases, with the same rate of complications, but a longer operative time. In our study, morbidity with TARS appears comparable to OpenT since the percentage of postoperative complications, such as hypoparathyroidism or recurrent laryngeal nerve injury, is similar to those reported in several meta-analyses [7, 10].…”

“…One of the reasons is that most of the nodules in Korean publications are smaller than our series (largest diameter of around 10 mm vs. 20 mm in our series). American [15] and Chinese [13] meta-analyses of Korean articles showed that the postoperative Tg level after TARS was significantly higher than after openT, but the interpretation remains difficult because some patients had only lobectomy, the condition and the time of postoperative Tg dosage were not specified, and the use of RAI was not specified.…”

The Surgical Robot: Applications and Advantages in General Surgery

“…However, the robotic approach was comparable to open thyroidectomy for cancer regarding morbidity, short-term recurrence rates, and quality of life outcomes. The authors warn that the technique for this indication should be reserved to the experts at high-volume centers [75]. A few years earlier, a large case series of robotic thyroidectomy for cancer had precisely shown that the robotic approach has decreased operative times and improved lymph node yields compared to the endoscopic technique.…”