Transoral robotic thyroidectomy (TORT): procedures and outcomes

Richmon, Jeremy D.; Kim, Hoon Yub

doi:10.21037/gs.2017.05.05

Cited by 79 publications

(85 citation statements)

References 23 publications

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“…The latest development in the field relates to transoral robotic thyroidectomy [52]. Following animal and cadaveric studies, this procedure was first performed in live humans in 2016, and its safety and feasibility were demonstrated in both American and South Korean patients [52].…”

Section: Current Status Novel Approaches and Future Rolementioning

confidence: 99%

“…Following animal and cadaveric studies, this procedure was first performed in live humans in 2016, and its safety and feasibility were demonstrated in both American and South Korean patients [52]. Though it is too early to appreciate its role in modern thyroid surgery, it is important to state that transoral robotic thyroidectomy represents the only “truly scarless” robotic thyroidectomy approach and the first application of natural orifice transluminal endoscopic surgery in thyroid surgery [7].…”

Section: Current Status Novel Approaches and Future Rolementioning

confidence: 99%

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Robotic Thyroid Surgery: Current Perspectives and Future Considerations

Aïdan

Arora

Lőrincz

et al. 2018

ORL

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Robotic transaxillary thyroidectomy, pioneered in South Korea, is firmly established throughout the Far East but remains controversial in Western practice. This relates to important population differences (anthropometry and culture) compounded by the smaller mean size of thyroid nodules operated on in South Korea due to a national thyroid cancer screening programme. There is now level 2 evidence (including from Western World centres) to support the safety, feasibility, and equivalence of the robotic approach to its open counterpart in terms of recurrent laryngeal nerve injury, hypoparathyroidism, haemorrhage, and oncological outcomes for differentiated thyroid cancer. Moreover, robotic thyroidectomy has been shown to be superior to open surgery for certain patient-reported outcome measures, namely scar cosmesis and pain. Downsides include its high cost, longer operative time, and risk of complications not encountered in open thyroidectomy (brachial plexus neurapraxia). Careful patient selection is paramount as this procedure is not for every patient, surgeon, or hospital. It should only be undertaken by high-volume surgeons operating as part of a multidisciplinary robotic team in specialised centres. Novel robotic approaches utilising the retroauricular and transoral routes for thyroidectomy have recently been described but further studies are required to establish their respective role in modern thyroid surgery.

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Section: Current Status Novel Approaches and Future Rolementioning

confidence: 99%

Section: Current Status Novel Approaches and Future Rolementioning

confidence: 99%

Robotic Thyroid Surgery: Current Perspectives and Future Considerations

Aïdan

Arora

Lőrincz

et al. 2018

ORL

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“…Additional inclusion criteria across authors accounted for diameter and/ or volume of the thyroid, size of the dominant nodule, and preoperative pathology (22–24,27,30,31). Specific inclusion criteria varied some between authors, most notably in regard to size limitations as per preoperative ultrasonography.…”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

“…Conversely, Kim et al . utilized a 4-cm nodule maximum, regardless of suspected pathology in their robotic series (24,25). …”

Section: Indications and Inclusion Criteriamentioning

confidence: 99%

“…Patients whom were deemed unfit for surgery or could not tolerate general anesthesia were also excluded (22–24,27,30,38). Most high-volume authors additionally note that lymph node metastasis and evidence of extrathyroidal extension such as tracheal or esophageal invasion should be contraindications (24,25,27,36,39,40). Dionigi et al .…”

Section: Contraindications and Exclusion Criteriamentioning

confidence: 99%

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Indications and contraindications to transoral thyroidectomy

Razavi

Russell

2017

Ann. Thyroid

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Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA). TOR/ETVA continues to become more prevalent given its early success in North America and the demonstration of its safety and efficacy in Asia. As more surgeons perform this procedure, it is important that specific and uniform indications and contraindications exist to prevent surgical complications due to poor patient selection. In this article, we review the existing English literature regarding TOR/ETVA and compile the inclusion and exclusion criteria of individual authors for both robotic and endoscopic techniques to date. We then resolve differences in the existing literature to provide recommended indications and contraindications to TOR/ETVA based on both our review and our own experience with TOR/ETVA to date. The following are our resultant recommended indications for TOR/ETVA: patient history of hypertrophic scarring or motivation to avoid a cervical neck incision with a maximal thyroid diameter ≤ 10 cm and dominant nodule ≤6 cm, with one of the following pathologic criteria; benign lesion, multinodular goiter, indeterminate nodule, or suspicious lesions/well-differentiated thyroid carcinomas ≤ 2 cm. Recommended contraindications to TOR/ETVA are as follows: history of head & neck surgery, history of head, neck, or upper mediastinal irradiation, inability to tolerate general anesthesia, evidence of clinical hyperthyroidism, preoperative recurrent laryngeal nerve palsy, lymph node metastasis, extrathyroidal extension including tracheal or esophageal invasion, oral abscesses, substernal thyroidal extension, or failure to meet inclusion criteria as above. Relative contraindications include smoking and other oral pathology, and surgeons should be aware that morbid obesity may make it difficult to raise skin flaps.

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