Abstract
Purpose:
Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach.
Methods:
One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed.
Results:
Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7).
REFERENCES
1.National Cancer Center. Annual report of National Cancer Registration Program. Seoul: Ministry of Health and Welfare;2007.
2.Shimizu K., Akira S., Jasmi AY., Kitamura Y., Kitagawa W., Akasu H, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg. 1999. 188:697–703.
3.Miccoli P., Berti P., Bendinelli C., Conte M., Fasolini F., Martino E. Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbecks Arch Surg. 2000. 385:261–4.
4.Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1996. 83:875.
5.Hüscher CSG., Chiodini S., Napolitano C., Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997. 11:877.
6.Park YL., Shin JH., Bae WK. Endoscopic thyroidectomy. J Korean Surg Soc. 2000. 59:25–9.
7.Ohgami M., Ishii S., Arisawa Y., Ohmori T., Noga K., Furukawa T, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000. 10:1–4.
8.Gagner M. Inabnet WB III Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid. 2001. 11:161–3.
9.Shimazu K., Shiba E., Tamaki Y., Takiguchi S., Taniguchi E., Ohashi S, et al. Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc. 2003. 13:196–201.
10.Choe JH., Kim SW., Chung KW., Park KS., Han W., Noh DY, et al. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg. 2007. 31:601–6.
11.Ikeda Y., Takami H., Sasaki Y., Kan S., Niimi M. Endoscopic neck surgery by axillary approach. J Am Coll Surg. 2000. 191:336–40.
12.Ikeda Y., Takemi H., Sasaki Y., Tagayama J., Niimi M., Kan S. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg. 2003. 196:189–95.
13.Yoon JH., Park CH., Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech. 2006. 16:226–31.
14.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. 23:2399–406.
17.Gutt CN., Oniu T., Mehrabi A., Kashfi A., Schemmer P., Buchler MW. Robot-assisted abdominal surgery. Br J Surg. 2004. 91:1390–7.
18.UICC-AJCC. Head and neck tumors, thyroid gland. Sobin LH, Wittekind CH, editors. editors.TNM Classification of Malignant Tumors. 6th ed.New York: Wiley;2003. p.52.
19.Link RE., Bhayani SB., Kavoussi LR. A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg. 2006. 243:486–91.
20.Bhattacharyya N., Fried MP. Benchmarks for mortality, morbidity, and length of stay for head and neck surgical procedures. Arch Otolaryngol Head Neck Surg. 2001. 127:127–32.
21.Chisholm EJ., Kulinskaya E., Tolley NS. Systemic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 2009. 119:1135–9.
22.Steinmuller T., Klupp J., Wenking S., Neuhaus P. Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg. 1999. 384:50–3.
23.Henry JF., Gramatica L., Denizot A., Kvachenyuk A., Puccini M., Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998. 383:167–9.
24.Roh JL., Park JY., Park CI. Total thyroidectomy plus neck dissection in differentiated thyroid papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007. 245:604–10.