Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study

Various robotic surgical procedures have been performed in recent years, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. This study aimed to introduce the authors' technique of robot-assisted endoscopic thyroid surgery and to demonstrate its applicability in the surgical management of thyroid cancer. From 4 October 2007 through 14 March 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci S surgical robot system. Four robotic arms were used with this system: a 12-mm telescope and three 8-mm instruments. The three-dimensional magnified visualization obtained by the dual-channel endoscope and the tremor-free instruments controlled by the robotic systems allowed surgeons to perform sharp and precise endoscopic dissections. Ipsilateral central compartment node dissection was used for 84 less-than-total and 16 total thyroidectomies. The mean operation time was 136.5 min (range, 79-267 min). The actual time for thyroidectomy with lymphadenectomy (console time) was 60 min (range, 25-157 min). The average number of lymph nodes resected was 5.3 (range, 1-28). No serious complications occurred. Most of the patients could return home within 3 days after surgery. The technique of robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.

Recently, robotic technology in the surgical area has gained wide popularity. However, in the filed of head and neck surgery, the applications of robotic instruments are problematic owing to spatial and technical limitations. The authors performed robot-assisted endoscopic thyroid operations in consecutive thyroid tumor patients using the newly introduced da Vinci S surgical system. Herein the authors describe the technique used and its utility for the operative management of thyroid tumors. From October 2007 to November 2008, 338 patients underwent robot-assisted endoscopic thyroid operations using a gasless, transaxillary approach. All procedures were successfully completed without conversion to an open procedure. Patient's clinicopathologic characteristics, operation types, operation times, the learning curve, and postoperative hospital stays and complications were evaluated. The mean patient age was 40 years (range, 16-69) and the male to female ratio was 1:16.8. Two hundred and thirty-four patients underwent less than total and 104 underwent bilateral total thyroidectomy. Ipsilateral central compartment node dissection was conducted in all malignant cases. Mean operation time was 144.0 minutes (range, 69-347) and mean postoperative hospital stay was 3.3 days (range, 2-7). No serious postoperative complication occurred; there were 3 cases of recurrent laryngeal nerve injury and 1 of Horner's syndrome. Our technique of robotic thyroid surgery using a gasless, transaxillary approach is feasible and safe in selected patients with a benign or malignant thyroid tumor.