“A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience.”
Lang, B. H. and M. P. Chow (2011).
Surgical Endoscopy 25(5): 1617-1623.
BACKGROUND: The gasless, transaxillary endoscopic thyroidectomy (GTET) offers a distinct advantage over the conventional open operation by leaving no visible neck scar, and in an attempt to improve its ergonomics and surgical outcomes, the robotically assisted thyroidectomy (RAT) was introduced. The RAT uses the same endoscopic route as the GTET but with the assistance of the da Vinci S robotic system. Excellent results for RAT have been reported, but it remains unclear whether RAT offers any potential benefits over GTET. METHODS: From June to December 2009, 46 patients underwent endoscopic thyroidectomy. Of these patients, 39 had surgery without the robot (GTET) and 7 had surgery with the robot (RAT). Demographics, surgical indications, operative findings, and postoperative outcomes were compared between the two groups. All the patients were followed up for at least 6 months after surgery. RESULTS: Patient demographics, surgical indications, and extent of resection were similar between the two groups. The median total procedure time was significantly longer for RAT (149 min) than for GTET (100 min; p=0.018), but the contralateral recurrent laryngeal nerve was more likely to identified in RAT (100%) than in GTET (42.9%; p=0.070). On the average, GTET needed one more surgical assistant than RAT (1 vs. 0; p<0.001). The median pain score on postoperative day 0 was significantly higher with RAT than with GTET (4 vs. 2; p=0.025) but was similar on day 1. Blood loss, hospital stay, and surgical complications were similar in the two groups. CONCLUSIONS: In our early experience, adding the da Vinci S robot to GTET increased the total procedure time and resulted in a higher pain score on day 0 but eliminated the need for any surgical assistant at the time of the operation.
“Role of robotic surgery in oral and maxillofacial, and head and neck surgery.”
Borumandi, F., M. Heliotis, et al. (2011).
British Journal of Oral and Maxillofacial Surgery.
We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.
“Outcomes of transoral robotic surgery: a preliminary clinical experience.”
Hurtuk, A., A. Agrawal, et al. (2011).
Otolaryngology and Head and Neck Surgery 145(2): 248-253.
Objective. To report a single institution’s experience with transoral robotic surgery (TORS) and its clinical outcomes. Study Design. Preliminary clinical data from a prospective TORS study. Setting. University tertiary care facility. Subjects and Methods. Patients who underwent TORS at The Ohio State University Medical Center. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected. Results. Sixty-four patients underwent TORS with a median age of 56.9 years. A total of 113 TORS procedures were performed. Fifty-four patients with squamous cell cancer (SCCA) were included in the final analysis. Mean follow-up time was 11.8 months (range, 2-29). There was a trend toward longer TORS setup time, operative time, estimated blood loss, and hospital length of stay with advanced (T(3)) compared with early-stage tumors (T(1-2)). There were no major intraoperative complications, and none of the procedures were aborted because of inability to remove the tumor. Negative resection margins were achieved in 93% of cases of SCCA. No patients experienced immediate postoperative complications, and all of the patients tolerated an oral diet without any airway compromise on the day of surgery. Forty-nine patients (91%) underwent adjuvant radiation therapy (RT), with 11 patients requiring gastrostomy tube placement during RT. Addition of TORS to overall management of head and neck SCCA spared adjuvant RT or combined chemotherapy and RT (CRT) in 50% of stage I/II tumors and spared chemotherapy in 34% of stage III/IV tumors. Conclusion. TORS is a safe procedure with minimal complications and favorable clinical and functional outcomes. It is a promising future alternative surgical treatment for laryngopharyngeal tumors.
“Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma.”
Kang, S. W., J. H. Park, et al. (2011).
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 21(4): 223-229.
PURPOSE: Robotic surgical systems are among the most innovative surgical developments and have radically promoted the use of minimally invasive techniques. Robotic technologies using different approaches have also been applied to thyroid surgery. Recently, the authors described a novel robotic surgical method for thyroid surgery based on a gasless, transaxillary approach (TAA), and have since serially reported on its technical feasibility and safety. Here, the authors report their experience of a consecutive series of 1000 cases treated using robotic thyroidectomy, and demonstrate its use for the surgical management of thyroid cancer. PATIENTS AND METHODS: From October 2007 to November 2009, 1000 patients with thyroid cancer underwent robot-assisted endoscopic thyroid surgery using a gasless TAA. All patients were selected using predetermined inclusion criteria after considering surgical risk, and all procedures were completed successfully using the da Vinci S or Si surgical system (Intuitive Surgical, Sunnyvale, CA). Patient’s clinicopathologic characteristics, operation types, operation times, numbers of retrieved lymph nodes (LNs), postoperative hospital stays, complications, and short-term follow-up results were analyzed. RESULTS: Mean patient age was 39.1+/-9.6 years and the male-to-female ratio was 1:12.6 (73:927). Six hundred twenty-seven patients underwent less than total and 373 patients underwent bilateral total thyroidectomy. Ipsilateral central compartment node dissection was conducted in all 1000 cases and additional lateral neck node dissection was conducted in 36 of the 1000 patients. Mean operation time was 136.7+/-44.4 minutes and mean postoperative hospital stay was 3.0+/-0.45 days. No serious postoperative complication occurred, except 3 cases of recurrent laryngeal nerve injury, and 1 case of Horner syndrome. Mean tumor size was 0.79+/-0.6 cm and papillary thyroid microcarcinoma was in 752 cases (75.5%). The mean number of retrieved central LNs per patient was 4.62+/-3.14. Central neck LN metastasis occurred in 361(36.1%) and lateral neck LN metastasis in 36 cases (3.6%). According to tumor nodes metastasis staging, 847 patients (84.7%) were of stage I, 144 patients (14.4%) were of stage III, and 9 patients (0.9%) were of stage IVA. CONCLUSIONS: The authors conclude that robotic thyroidectomy using a gasless TAA is a feasible, safe, and promising surgical alternative for selected patients with low-risk thyroid cancer, and recommend that the inclusion criteria of this technique be gradually extended to advanced thyroid cancer given suitable operator experience and future developments in robotic systems and instrumentation.
“A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience.”
Lang, B. H. and M. P. Chow (2011).
Surgical Endoscopy 25(5): 1617-1623.
BACKGROUND: The gasless, transaxillary endoscopic thyroidectomy (GTET) offers a distinct advantage over the conventional open operation by leaving no visible neck scar, and in an attempt to improve its ergonomics and surgical outcomes, the robotically assisted thyroidectomy (RAT) was introduced. The RAT uses the same endoscopic route as the GTET but with the assistance of the da Vinci S robotic system. Excellent results for RAT have been reported, but it remains unclear whether RAT offers any potential benefits over GTET. METHODS: From June to December 2009, 46 patients underwent endoscopic thyroidectomy. Of these patients, 39 had surgery without the robot (GTET) and 7 had surgery with the robot (RAT). Demographics, surgical indications, operative findings, and postoperative outcomes were compared between the two groups. All the patients were followed up for at least 6 months after surgery. RESULTS: Patient demographics, surgical indications, and extent of resection were similar between the two groups. The median total procedure time was significantly longer for RAT (149 min) than for GTET (100 min; p=0.018), but the contralateral recurrent laryngeal nerve was more likely to identified in RAT (100%) than in GTET (42.9%; p=0.070). On the average, GTET needed one more surgical assistant than RAT (1 vs. 0; p<0.001). The median pain score on postoperative day 0 was significantly higher with RAT than with GTET (4 vs. 2; p=0.025) but was similar on day 1. Blood loss, hospital stay, and surgical complications were similar in the two groups. CONCLUSIONS: In our early experience, adding the da Vinci S robot to GTET increased the total procedure time and resulted in a higher pain score on day 0 but eliminated the need for any surgical assistant at the time of the operation.
“Bilateral axillo-breast approach robotic thyroidectomy.”
Lee, K. E., J. Y. Choi, et al. (2011).
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 21(4): 230-236.
BACKGROUND: : Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) has good postoperative and excellent cosmetic outcomes. This study aimed to describe the techniques for robotic BABA thyroidectomy in detail (see Videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A45 and Supplemental Digital Content 2, http://links.lww.com/SLE/A46). METHODS: : Between 2008 and 2010, 704 patients underwent BABA RoT. The mean patient age was 38.9+/-9.1 years and the male-to-female ratio was 1:8.0. BABA RoT is an oncoplastic thyroid surgery using BABA and da Vinci robot system with low pressure of CO2 gas insufflations. RESULTS: : The operation types were as follows: total thyroidectomy with or without neck dissection (n=556, 78.9%), subtotal thyroidectomy (n=67, 9.5%), lobectomy (n=73, 10.4%), and completion thyroidectomy (n=8, 1.1%). CONCLUSIONS: : BABA RoT yields good postoperative outcomes. With excellent cosmetic outcomes, this technique may be a suitable alternative for patients with thyroid diseases.
“Advances in surgical therapy for thyroid cancer.”
Mazeh, H. and H. Chen (2011).
Nature Reviews. Endocrinology.
Thyroid cancer is the most common malignancy of the endocrine system and its incidence has dramatically increased over the past three decades. Well-differentiated thyroid cancers (DTCs) are the main focus of this article, as they represent >90% of thyroid malignancies. This Review provides an overview of the controversies surrounding the optimal choice of surgery and extent of resection for patients with low-risk DTC or with papillary thyroid microcarcinoma, and the role of prophylactic central lymph node dissection. This Review also outlines the current surgical management of DTC and presents updated results for these techniques, along with important advances and current dilemmas in surgical approaches to treatment of these cancers. For example, endoscopic and robotic thyroidectomy are the two most recent innovations to present technical and other challenges to the endocrine surgeon; in addition, the risks as well as the advantages of same-day thyroid surgery, which has gained some acceptance, are detailed. Arguments for and against each approach are presented, along with supporting evidence. The authors’ personal opinions are also provided for each topic.
“Robotic facelift thyroidectomy: patient selection and technical considerations.”
Terris, D. J., M. C. Singer, et al. (2011).
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 21(4): 237-242.
OBJECTIVES: : A series of remote access thyroidectomy techniques, some using a surgical robot, have been introduced in the last decade. Most of these approaches require awkward positioning, use unfamiliar dissection planes, and have been associated with a number of significant complications. As a result, acceptance has been limited. We describe technical details and patient selection criteria of a recently described robotic facelift thyroidectomy (RFT) approach that avoids these pitfalls. DESIGN: : Analysis of preclinical and clinical studies. METHODS: : Inanimate and cadaver dissection studies and clinical implementation were pursued. A 3-arm RFT technique with a 30-degree offset base location proved optimal. Supine positioning with arms tucked and the patient in slight Trendelenburg position facilitated the dissection of the optical pocket. Demographic and surgical data that have been obtained and considered include patient age, sex, body mass index, pathology, and complications. RESULTS: : A series of consecutive RFT procedures has been accomplished in a limited population of patients. All cases were completed robotically with no conversions to open surgery necessary. All but the first case was accomplished on a drainless, outpatient basis. CONCLUSIONS: : A RFT technique that is gasless and uses a single access port in the postauricular crease and occipital hairline location is feasible, technically less challenging than other remote access methods, and safe. Further study in an expanded patient population and in additional high-volume thyroid centers is warranted. See the videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A36andSupplementalDigitalContent2, http://links.lww.com/SLE/A37.