191
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Recently, a transoral robotic-assisted technique to access the thyroid gland has been introduced. Despite the advantages this approach may have over other minimally invasive and robotic-assisted techniques, we found that the placement of the camera through the floor of mouth led to restricted freedom of movement. We describe our modification to this technique to overcome this problem. In a study using two fresh human cadavers, the camera port of the da Vinci robot was placed in the midline oral vestibule instead of the floor of the mouth. A transoral thyroidectomy and central neck dissection was successfully performed. Our modification led to an unfettered view of the central neck and allowed for a total thyroidectomy and central neck dissection. Our modification of transoral robotic-assisted thyroidectomy provides superior access to the central compartment of the neck over other robotic-assisted thyroidectomy techniques.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s11701-011-0287-2) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references 13

          • Record: found
          • Abstract: found
          • Article: not found

          Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients.

          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.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients.

            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.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The learning curve for robotic thyroidectomy: a multicenter study.

              The learning curve for robotic thyroidectomy with central compartment node dissection (CCND) has not been established. We examined the effect of experience of robotic thyroidectomy on a range of perioperative parameters in order to determine the learning curve. The learner surgeon outcomes were compared with those of an experienced surgeon. We conducted a prospective, controlled, multicenter study involving four endocrine surgeons at three academic centers. Patients underwent robotic total or subtotal thyroidectomy with CCND between September 2008 and October 2009. One surgeon was experienced in the technique (experienced surgeon, ES), while the other three surgeons had endoscopic thyroid surgery experience but no experience performing the robotic procedure (nonrobotic thyroid surgery experienced surgeon, NS). Outcome measures were demographic data, operative time, blood loss, hospital stay, pathologic results, and postoperative complications. A total of 644 total or subtotal robotic thyroidectomies with CCND were performed: 377 (58.7%) by NSs and 267 (41.5%) by the ES. Mean operative time was longer and the complication rate was higher for the NS patient group compared with the ES patient group (P < 0.001 for each). The operative times and complications rates for the NS group were similar to those of the ES group once the NSs had performed 50 cases for total thyroidectomies or 40 cases for subtotal thyroidectomies. The learning curve duration for robotic thyroidectomy with CCND using gasless transaxillary approach for experienced endoscopic thyroidectomy surgeons was 50 cases for total thyroidectomy and 40 cases for subtotal thyroidectomy.
                Bookmark

                Author and article information

                Contributors
                +1-410-9553628 , rtufano1@jhmi.edu
                Journal
                J Robot Surg
                Journal of Robotic Surgery
                Springer-Verlag (London )
                1863-2483
                1863-2491
                15 June 2011
                15 June 2011
                December 2011
                : 5
                : 4
                : 279-282
                Affiliations
                [1 ]Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, 601 N. Caroline Street 6th Floor, Blatimore, MD 21287 USA
                [2 ]Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
                [3 ]Department of Surgery, Tulane University, New Orleans, LA USA
                Article
                287
                10.1007/s11701-011-0287-2
                3214254
                22162981
                © Springer-Verlag London Ltd 2011
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag London Ltd 2011

                Surgery

                robot, robotic-assisted surgery, transoral thyroidectomy, central neck, thyroid, minimally invasive

                Comments

                Comment on this article