ORIGINAL ARTICLE

Robotic Thyroid Surgery for Papillary Thyroid Carcinoma: Lessons Learned From 100 Consecutive Surgeries Hye Yoon Lee, MD, In Soo Yang, MD, Seong Bae Hwang, MD, PhD, Jae Bok Lee, MD, PhD, Jeoung Won Bae, MD, PhD, and Hoon Yub Kim, MD, PhD

Purpose: To evaluate the feasibility and safety of robotic thyroidectomy using the da Vinci surgical system. Patients and Methods: Between July 2008 and April 2011, the data revealed an initial series of 100 consecutive patients who underwent robotic thyroidectomy with the da Vinci-S surgical system using the bilateral axillo-breast approach for thyroid cancer. Prospectively collected data were analyzed retrospectively. Results: There were 88 cases of total thyroidectomy, 11 cases of lobectomy, and 1 case of total thyroidectomy with modified radical neck dissection. There was no conversion. The mean total operation time was 287.15 ± 45.19 minutes for total thyroidectomy and 236.27 ± 48.98 minutes for lobectomy. Nineteen patients experienced transient hypocalcemia and 3 patients experienced transient vocal fold palsy. All of the patients recovered within 3 months. Conclusions: Robotic thyroid surgery for patients with thyroid malignancy is safe and results in fewer postoperative complications than open thyroid surgery. Key Words: robotic surgery, thyroid cancer, bilateral axillo-breast approach

(Surg Laparosc Endosc Percutan Tech 2015;25:27–32)

O

ver the last decade, endoscopic surgery techniques have been used in minimally invasive surgery in many areas. Endoscopic surgery was initially performed for neck surgery in 1996 by Gagner and has been widely accepted as being feasible and safe. Several studies have demonstrated that this minimally invasive approach has better outcomes than open surgery in terms of cosmesis, hospital stay, postoperative pain, and return to normal life. Similar oncologic outcomes and morbidities were reported in previous studies.1–3 Nevertheless, there are some challenges with endoscopic thyroid surgery, such as the 2-dimensional view and nonflexible instruments, which impede the operator’s accurate manipulation and adequate view.2,4 Robotic thyroidectomy was developed in late 2007 in South Korea. The da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) has overcome the limitations of endoscopic thyroid surgery by providing a Received for publication March 29, 2013; accepted June 7, 2013. From the Department of Surgery, Korea University College of Medicine, Seoul, Korea. I.S.Y. is a co-first author. The research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology. (2012R1A1A1013413). The authors declare no conflicts of interest. Reprints: Hoon Yub Kim, MD, PhD, Department of Surgery, Korea University College of Medicine, 126-1 Anam-dong, Seongbuk-gu, Seoul 136-705, Korea (e-mail: [email protected]). Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.

Surg Laparosc Endosc Percutan Tech



3-dimensional view, tremor filtration, fine motion, and multiarticulated instruments. Several studies about robotic thyroidectomy have been published and demonstrate the superiority of the new technique in terms of postoperative complications and oncologic outcomes.5,6 The authors performed robotic total thyroidectomy or lobectomy with sentinel neck dissection with the da Vinci robotic surgical system in the first 2 years of the study. All operations were conducted using the bilateral axillo-breast approach (BABA). We collected data on patients who had proven thyroid malignancy and evaluated the safety and feasibility of robotic thyroidectomy for thyroid cancer.

PATIENTS AND METHODS Patients Between July 2008 and April 2011, 122 patients with thyroid tumors underwent BABA robotic thyroid surgery (da Vinci-S surgical robotic surgical system) at Korea University Anam Hospital, Seoul, Korea by a single surgeon. We included 100 patients who had been diagnosed with thyroid cancer on the final pathologic report and evaluated the patient demographics, operation types, operation times, postoperative hospital stays, complications, and pathologic characteristics from the prospectively collected database. The indications of robotic thyroidectomy were: (1) well-differentiated thyroid carcinoma with a tumor size of r2 cm without definite evidence of nodal metastasis (cT1N0); (2) follicular neoplasm with a tumor size of r5 cm; and (3) other thyroid tumors (benign, indeterminate, atypical cell) with a tumor size of r5 cm. Patients who had a history of previous neck surgery were excluded. Patients who had preoperatively suspicious thyroid malignancy with extrathyroidal extension or definite neck node metastases were also excluded. Lobectomy was performed for patients who were diagnosed as having no malignancy (follicular neoplasm, benign, indeterminate, atypical cell) on preoperative cytologic report and for women who were younger than 45 years and diagnosed with a single nodule of malignancy

Robotic thyroid surgery for papillary thyroid carcinoma: lessons learned from 100 consecutive surgeries.

To evaluate the feasibility and safety of robotic thyroidectomy using the da Vinci surgical system...
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