Surgery for Graves’ disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population

Garstka, Meghan; Kandil, Emad; Saparova, Lachin; Bechara, Maroun; Green, Rebecca; Haddad, Antoine; Kang, Sang‐Wook; Aïdan, Patrick

doi:10.1007/s00423-018-1713-y

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…Other complications were transient or resolved during the surgery. RTT has a predominant complication of transient hypocalcemia (21%), which is similar to other reports [25, 30, 31]. We had one patient with transient brachial plexopathy that was resolved within 2 months.…”

Section: Discussionsupporting

confidence: 88%

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Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study

et al. 2022

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Background Despite the increase in experience and understanding of robotic thyroidectomy, its application for Graves' disease (GD) remains controversial. This study aimed to assess the safety and feasibility of robotic transaxillary thyroidectomy (RTT) for GD in comparison with the conventional open thyroidectomy (open group: OG) approach. Methods A total of 192 patients who underwent surgical resection for GD were retrospectively reviewed. Among them, 51 patients underwent RTT and the remaining 141 patients were in the conventional OG. Results All robotic operations were performed successfully without open conversion. Patients who underwent RTT were significantly younger (P < 0.001) and predominantly of the female sex. Operative time was longer for RTT than for the OG (182.5 ± 58.1 vs. 112.0 ± 29.5; P < 0.001). The mean intraoperative blood loss was not statistically different between RTT and the OG (113.3 ± 161.6 vs. 95.3 ± 209.1, P = 0.223). The mean weight of the resected thyroid was reduced in those who underwent RTT compared with open thyroidectomy (P = 0.033). The overall complication rate for RTT and open thyroidectomy was not significantly different (33.3% vs. 22.7%, P = 0.135). In RTT, the most common complication was transient hypocalcemia (21%). Permanent hypocalcemia and recurrent laryngeal nerve injury occurred in only one patient in each group. The weight of the resected thyroid was not related to the incidence of complications in patients receiving RTT. Conclusions Considering excellent cosmesis, findings of this study support the safety and feasibility of RTT. Nevertheless, it should be performed by expert surgeons with extensive robotic surgery experience.

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Section: Discussionsupporting

confidence: 88%

“…Our results found that RTT for GD had longer operative times. Similar results were observed in robotic‐assisted transaxillary thyroidectomy and BABA robotic thyroidectomy [30, 31]. These findings were influenced by the flap dissection that was made to obtain sufficient working space, docking, and console time to retrieve a large thyroid.…”

Section: Discussionsupporting

confidence: 72%

Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study

et al. 2022

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“…Numerous reports over the last years suggest that minimally invasive video-assisted operations (MIVAT [23]) or remote access robotic procedures (bilateral-axillo-breast approach [24], transaxillary approach [25,26]) for the surgical treatment of GD are accepted and frequently used throughout the thyroid community. In Germany, however, these procedures do not play a role in patients with GD, since only 1.3 resp.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

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“…It is commonly known that in most cases the vocal fold mobility is impaired due to the damage to the recurrent laryngeal nerves during surgeries [4,6]. The recurrent laryngeal nerves can be damaged due to the deformation and anatomical mapping relationships caused by significant thyroid enlargement, anatomical proximity of the recurrent laryngeal nerve to the inferior thyroid artery, excessive use of electric coagulation, postoperative edemas, hematoma or nerve involvement into a cicatrization [20,22].…”

Section: Resultsmentioning

confidence: 99%

Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies

Shliakhtych¹,

Antoniv²

2021

ЗХ

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Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery. Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD. Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group 1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods. Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level). Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be noted that TT provides lower risk of complications due to significantly lower level of TSHR‑Ab in late postoperative period.

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Surgery for Graves’ disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population

Cited by 13 publications

References 8 publications

Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study

Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies

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