Abstrakt ORL Červen 2011

“Robotic transaxillary total thyroidectomy using a unilateral approach.”

Berber, E. and A. Siperstein (2011).

Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 21(3): 207-210.


There has been a recent interest at performing thyroid procedures robotically through an axillary approach. Although the technique for a unilateral thyroid lobectomy has been well established, there are controversies about whether a unilateral or bilateral axillary approach should be used for total thyroidectomy. Furthermore, there also questions as to whether a robotic total thyroidectomy would be oncologically equivalent to the traditional procedure. We have been performing our robotic total thyroidcetomies through a unilateral axillary approach, using principles learned in traditional surgery for removing substernal goiter. In this report, we describe a technique of robotic unilateral transaxillary total thyroidectomy validated by follow-up radioactive iodine uptake and serum thyroglobulin data.




“Perianaesthetic concerns for the new robot-assisted transaxillary thyroid surgery: A report of seven first cases.”

Boccara, G., T. Guenoun, et al. (2011).

Implications anesthésiques de la chirurgie thyroïdienne ou parathyroïdienne par voie axillaire sous robot-assistance : à propos de sept premiers cas.


The gasless transaxillary robot-assisted endoscopic thyroid surgery is recently proposed and developed in South Corea and USA. We reported the perianaesthestic concerns for the seven first patients scheduled to undergo this innovative surgical technique in France. The anaesthetic considerations focused on the length of surgery according to the learning curve, the risk of the arm posture and the postoperative painful evaluation and relief. © 2011 Elsevier Masson SAS. All rights reserved.




“Transoral robotic reconstructive surgery reconstruction of a tongue base defect with a radial forearm flap.”

Garfein, E. S., P. J. Greaney Jr, et al. (2011).

Plastic and Reconstructive Surgery 127(6): 2352-2354.




“Robotic-assisted lingual tonsillectomy.”

Hurtuk, A., T. Teknos, et al. (2011).

Laryngoscope 121(7): 1480-1482.




“Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands.”

Landry, C. S., E. G. Grubbs, et al. (2011).

Surgery 149(4): 549-555.


BACKGROUND: Robotic assisted transaxillary surgery (RATS) is a minimally invasive approach for the removal of the thyroid and/or parathyroid glands through the axilla. This anatomically directed technique, popularized by Chung, eliminates a visible scar and affords excellent high definition optics of the cervical anatomy. We report an initial series of single access RATS in the U.S. METHODS: The prospective endocrine surgery database at a tertiary care center was used to capture all patients who underwent RATS between October 2009 and March 2010. All procedures were performed using a single transaxillary incision. RESULTS: Fourteen operations were performed on 13 patients. Indications for RATS were indeterminate thyroid nodules in 11 patients, the need for completion thyroidectomy in 1 patient, and primary hyperparathyroidism in 2 patients. For patients who underwent robotic assisted thyroid lobectomy, the median thyroid nodule size was 2.1 cm (range, 0.8-2.8 cm), and the median body mass index was 25.33 (range, 21.3-34.4). Mean and median total operative times for robotic assisted thyroid lobectomies were 142 minutes and 137 minutes respectively (range, 113-192 minutes). Operative time for the 2 patients who underwent robotic assisted parathyroidectomy was 115 and 102 minutes. Minor complications occurred in 4 patients (28.5%), with no significant perioperative morbidity or mortality. CONCLUSION: RATS is feasible. We believe that further study of the RATS technique for removing thyroid lobes and parathyroid glands is warranted. This initial series suggests that careful, continued investigation is necessary prior to routine implementation into clinical practice across the U.S.




“Endoscopic vs Robotic Thyroidectomy: Which is Better?”

Lang, B. H., M. P. Chow, et al. (2011).

Annals of Surgical Oncology.




“The use of robotics in otolaryngology-head and neck surgery: a systematic review.”

Maan, Z. N., N. Gibbins, et al. (2011).

American Journal of Otolaryngology – Head and Neck Medicine and Surgery.


Background: Robotic surgery has become increasingly used due to its enhancement of visualization, precision, and articulation. It eliminates many of the problems encountered with conventional minimally invasive techniques and has been shown to result in reduced blood loss and complications. The rise in endoscopic procedures in otolaryngology-head and neck surgery, and associated difficulties, suggests that robotic surgery may have a role to play. Objective of review: To determine whether robotic surgery conveys any benefits compared to conventional minimally invasive approaches, specifically looking at precision, operative time, and visualization. Type of review: A systematic review of the literature with a defined search strategy. Search strategy: Searches of MEDLINE, EMBASE and CENTRAL using strategy: ((robot* OR (robot* AND surgery)) AND (ent OR otolaryngology)) to November 2010. Evaluation method: Articles reviewed by authors and data compiled in tables for analysis. Results: There were 33 references included in the study. Access and visualization were regularly mentioned as key benefits, though no objective data has been recorded in any study. Once initial setup difficulties were overcome, operative time was shown to decrease with robotic surgery, except in one controlled series of thyroid surgeries. Precision was also highlighted as an advantage, particularly in otological and skull base surgery. Postoperative outcomes were considered equivalent to or better than conventional surgery. Cost was the biggest drawback. Conclusions: The evidence base to date suggests there are benefits to robotic surgery in OHNS, particularly with regards to access, precision, and operative time but there is a lack of controlled, prospective studies with objective outcome measures. In addition, economic feasibility studies must be carried out before a robotic OHNS service is established. © 2011 Elsevier Inc. All rights reserved.




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

Richmon, J. D., F. C. Holsinger, et al. (2011).

Journal of Robotic Surgery: 1-4.


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. © 2011 Springer-Verlag London Ltd.




“Robotic facelift thyroidectomy: I. Preclinical simulation and morphometric assessment.”

Singer, M. C., M. W. Seybt, et al. (2011).



OBJECTIVES: Robotic thyroidectomy was introduced in the United States despite scant preclinical data. We pursued a systematic preclinical investigation of a new remote access, robotic thyroidectomy technique via a facelift incision, and sought to define differences in extent of dissection associated with this approach and a second, popular robotic thyroidectomy technique. DESIGN: Surgical simulation and morphometric analysis in fresh human cadavers. METHODS: Eleven specimens were obtained to complete four experiments designed to address two specific aims: to develop a reproducible surgical protocol for robotic removal of the thyroid through a facelift incision, and to quantify the extent of dissection required with two robotic thyroidectomy techniques. RESULTS: The feasibility of the facelift approach was determined using an endoscopic technique, and two lobectomies were accomplished. Inanimate study of the optimal robotic positioning to facilitate resection was then completed. Three additional cadavers were used to develop a reproducible surgical protocol and define a stepwise algorithm of dissection. Seven specimens were used to simulate 28 robotic thyroidectomy dissection pockets. The mean area of dissection required for robotic facelift thyroidectomy was 39.2 +/- 6.6 cm(2) compared with 63.5 +/- 9.6 cm(2) for robotic axillary thyroidectomy, representing a difference of 38.3% (P < .0001). CONCLUSIONS: We have described and refined a reproducible surgical protocol for accomplishing a new robotic facelift thyroidectomy, and then quantified the reduced dissection required when comparing it with a transaxillary technique. Cautious clinical implementation to explore safety and feasibility appears to be justified.




“Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience.”

Tae, K., Y. B. Ji, et al. (2011).

Head and Neck.


BACKGROUND: The efficacy of robotic thyroidectomy for thyroid cancer has not yet been assessed. The aim of this study was to evaluate the technical feasibility and completeness of robotic thyroidectomy for papillary thyroid carcinoma (PTC). METHODS: We analyzed 75 patients with PTC who underwent robotic thyroidectomy from October 2008 to August 2010 using a gasless unilateral axillo-breast or axillary approach with a da Vinci S Surgical System Robot and compared them with 226 patients who received conventional open thyroidectomy. RESULTS: The robotic thyroidectomy procedure was successfully completed in all the patients. The complication rate did not differ between the 2 groups, except for transient hypoparathyroidism. The surgical completeness of robotic thyroidectomy was comparable to that of conventional open thyroidectomy, and cosmetic satisfaction was superior in the robotic group. CONCLUSION: Robotic thyroidectomy is a safe, feasible, and cosmetically excellent procedure in properly selected patients with PTC. (c) 2011 Wiley Periodicals, Inc. Head Neck, 2011.