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Lee and Chung: Quality of Life Outcomes after Robotic Thyroid Surgery
Review Article

Clin Exp Thyroidol 2015;8(1):19-25.

Published online: 4 May 2015

DOI: https://doi.org/10.11106/cet.2015.8.1.19

Quality of Life Outcomes after Robotic Thyroid Surgery

Jandee Lee, Woong Youn Chung

Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Woong Youn Chung, MD, PhD, Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 120-752, Korea Tel: 82-2-2228-2098, Fax: 82-2-313-8289, E-mail: wounyounc@yuhs.ac

Received 7 May 2014       Accepted 24 June 2014

Copyright © 2015, the Korean Thyroid Association.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The robotic approach is the new frontier of thyroid cancer surgery, with several advantages over conventional open and endoscopic techniques. Recent assessments of quality of life (QoL) outcomes have found that patients undergoing robotic thyroid surgery using transaxillary approach experience lower levels of dissatisfaction and regret than patients undergoing conventional open thyroid surgery, largely due to differences in cosmetic outcomes. Prospective trials evaluating functional parameters, including pain, neck discomfort, and sensory changes in the neck, have favored robotic over conventional open thyroid surgery. Similarly, objective and subjective evaluations of voice and swallowing discomfort were improved in patients undergoing robotic thyroidectomy. Thus, use of a robot results in overall increases in cosmetic satisfaction and decreases in several measures of postoperative discomfort compared with the conventional open thyroid technique. However, a proper evaluation of QoL requires long-term assessments, and randomized controlled trials are necessary to definitively establish the real benefits of robotic surgery. This review provides merits and demerits of robotic thyroidectomy and radical neck dissection, based on published data, as well as comparing QoL outcomes after robotic and conventional open thyroidectomy.

Keywords: Robot, Thyroidectomy, Quality of life, Transaxillary, Cosmetic outcome

References

1. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS. et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009; 23(11):2399–406.
2. Lee J, Chung WY. Current status of robotic thyroidectomy and neck dissection using a gasless transaxillary approach. Curr Opin Oncol. 2012; 24(1):7–15.
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8. Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc. 2011; 25(1):221–8.
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9. Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW. Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years' experience. Head Neck. 2012; 34(5):617–25.
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11. Ryu HR, Lee J, Park JH, Kang SW, Jeong JJ, Hong JY. et al. A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: a prospective study. Ann Surg Oncol. 2013; 20(7):2279–84.
12. Lee J, Kwon IS, Bae EH, Chung WY. Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab. 2013; 98(7):2701–8.
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13. Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS. et al. Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc. 2012; 26(7):1871–7.
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Fig. 1.
Photography of a postoperative anterior neck incision scar. The patient showed severe hypertrophic scar 3 months after conventional open thyroidectomy.
jkta-8-19f1.tif
Fig. 2.
(A) Photograph of a postoperative single incision axillary scar 3 months after robotic thyroidectomy. (B) The patient's axillary scar is completely concealed when the arm is in its natural position.
jkta-8-19f2.tif
Table 1.
Comparison of pain, neck discomfort, and sensory changes after robotic versus conventional open thyroidectomy
Journal, year Study design Subject of QoL Cases (number) Exams Results
Surg Endosc, 20107) Prospective Pain and neck discomfort OT (43) vs. RT (41) Postoperative analgesic use, pain score RT similar to OT
Surg Endosc, 20118) Prospective Pain and neck discomfort OT (163) vs. RT (41) Pain score RT similar to OT
Head Neck, 20129) Retrospective Pain and neck discomfort OT (226) vs. RT (75) Pain score RT similar to OT
Surgery, 201310) Prospective Pain OT (30) vs. RT (16) Postoperative analgesic use, visual analogue scale RT similar to or worse than OT
Ann Surg Oncol, 201311) Prospective Pain OT (45) vs. RT (45) Postoperative analgesic use, visual analogue scale RT better than or similar to OT
J Clin Endocrinol Metab, 201312) Prospective Pain and neck discomfort O-MRND (66) vs. R-MRND (62) Pain score R-MRND much better than O-MRND
Head Neck, 20136) Meta-analysis Pain OT (794), ET (965), vs. RT (1122) Pain score RT similar to or better than OT
Surg Endosc, 20107) Prospective, single surgeon Sensory changes OT (43) vs. RT (41) Sensory score RT better than OT
Head Neck, 20129) Retrospective, single surgeon Sensory changes OT (226) vs. RT (75) Sensory score RT similar to OT
J Clin Endocrinol Metab, 201312) Prospective, single surgeon Sensory changes O-MRND (66) vs. R-MRND (62) Sensory score R-MRND better than O-MRND

O-MRND: open modified radical neck dissection, OT: open thyroidectomy, QoL: quality of life, R-MRND: robot modified radical neck dissection, RT: robotic thyroidectomy

Table 2.
Comparison of voice and swallowing disability robotic versus conventional open thyroidectomy
Journal, year Study design Subject of QoL Cases (number) Exams Results
Surg Endosc, 20107) Prospective Voice changes and swallowing discomfort OT (43) vs. RT (41) VHI-10 and SIS-6 RT similar to OT in voice changes
RT better than OT in swallowing discomfort
J Clin Endocrinol Metab, 201312) Prospective Voice changes and swallowing discomfort O-MRND (66) vs. R-RND (62) VHI-10 and SIS-6 R-MRND similar to O-MRND in voice changes
          R-MRND better than O-MRND in swallowing discomfort
Surg Endosc, 201213) Prospective Voice changes and swallowing discomfort OT (61) vs. RT (50) VSS, and SSS videolaryngostroboscopic examination, acoustic voice analysis, aerodynamic measurements RT better than OT in voice changes RT similar to OT in swallowing discomfort
Ann Surg Oncol, 201214) Prospective Voice changes OT (46) vs. RT (42) GRBAS scale videolaryngostroboscopic examination, acoustic voice analysis, electroglottography RT similar to OT in voice changes

GRBAS: overall grade of hoarseness (G), roughness (R), breathiness (B), asthenia (A), and strain (S), O-MRND: open modified radical neck dissection, OT: open thyroidectomy, QoL: quality of life, R-MRND: robot modified radical neck dissection, RT: robotic thyroidectomy, SIS-6: swallowing impairment index, SSS: swallowing symptom score, VHI-10: Voice Handicap Index-10, VSS: voice symptom score

Table 3.
Comparison of cosmetic outcomes after robotic versus conventional open thyroidectomy
Journal, year Study design Subject of QoL Cases (number) Exams Results
Surg Endosc, 20107) Prospective Cosmetic outcomes OT (43) vs. RT (41) Verbal response scale RT much better than OT
Surg Endosc, 20118) Prospective Cosmetic outcomes OT (163) vs. RT (41) Cosmetic satisfaction score RT much better than OT
Head Neck, 20129) Retrospective Cosmetic outcomes OT (226) vs. RT (75) Cosmetic satisfaction score RT much better than OT
J Clin Endocrinol Metab, 201312) Prospective Cosmetic outcomes O-MRND (66) vs. R-MRND (62) Verbal response scale R-MRND much better than O-MRND
Head Neck, 20136) Meta-analysis Cosmetic outcomes OT (794), ET (965), vs. RT (1122) Cosmetic satisfaction score RT much better than OT

O-MRND: open modified radical neck dissection, OT: open thyroidectomy, QoL: quality of life, R-MRND: robot modified radical neck dissection, RT: robotic thyroidectomy

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