Background Robotic thyroidectomy using a gasless transaxillary approach, first described in 2008, has become popular. This study compared outcomes, including postoperative distress and patient satisfaction, for patients undergoing robotic thyroidectomy with those for patients treated by conventional open thyroidectomy. Methods Of 84 prospectively enrolled patients, 41 underwent robotic thyroidectomy (the robot group), and 43 received conventional open thyroidectomy (the open group). All the patients were followed up for at least 3 months after surgery. Videolaryngostroboscopic examinations were performed preoperatively and after 1 week and after 3 months postoperatively. Postoperative pain and discomfort were evaluated using a symptom scale. Subjective voice and swallowing changes were assessed by questionnaires; and satisfaction with cosmetic outcome was measured by verbal response at 3 months. Results The two groups were similar in age, gender, type of operation, and final pathologic diagnosis. Although the mean operating time was significantly longer with the robotic technique than with open surgery, there were no betweengroup differences in postoperative pain or duration of hospital stay. No patient in either group experienced any major postoperative complication. Postoperative discomfort in the neck and swallowing disturbances were significantly more frequent in the open group than in the robot group, both at 1 week and at 3 months after surgery. However, there was no significant between-group difference in subjective voice parameters. At 3 months, the mean cosmetic satisfaction score was significantly higher in the robotic than in the open group. Conclusion Although postoperative pain levels and complications were comparable in the two groups, conventional open thyroidectomy requires a shorter operative time. The robotic technique, however, offers several distinct advantages including very good to excellent cosmetic results, reduced postoperative neck discomfort, and fewer adverse swallowing symptoms.Keywords Comparative study Á Cosmetic result Á Postoperative neck discomfort Á Robotic thyroidectomy Á Swallowing symptom Most patients with thyroid tumors are effectively treated surgically by practitioners experienced in the techniques of thyroidectomy. Many patients, especially women, undergoing thyroid surgery are concerned about the postoperative cosmetic appearance of the neck. Neck surgery also may result in postoperative discomfort, with pain, hyperesthesia, and paresthesia [1][2][3].

Objectives: Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures. Materials and Methods:Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII).Results: Although the mean operating time was significantly longer in the robotic (mean, 271.8 Ϯ 50.2 min) than in the open group (mean, 208.9 Ϯ 56.3 min) (P Ͻ .0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and neck dissection impairment index were also similar, but postoperative swallowing difficulties (P ϭ .0041) and sensory changes (P Ͻ .0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (P Ͻ .0001). dissection. The surgical techniques involved in robotic thyroidectomy and neck dissection continue to be refined, building on the principles and framework of new head and neck operative procedures (1-3). These refinements in- Conclusions

Purpose. 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. Methods. 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. Results. 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. Conclusion. 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.Endoscopic thyroid and parathyroid surgery have emerged as viable options for surgical management of thyroid tumors since the first descriptions of endoscopic parathyroidectomy by Gagner in 1996 and video-assisted thyroid lobectomy by Huscher in 1997.

Our study showed that DTC patients presenting with initial DM appear to have relatively favorable outcomes compared with DTC patients who developed DM after initial treatment. Complete local control may be the most important prognostic indicator in all DM patients. Metastatic lesion iodine avidity had a significant impact on both OS and DSS in patients developing DM after initial treatment, but significantly influenced only DSS in patients presenting with initial DM.

Even though robotic thyroidectomy using the transaxillary technique requires a more extensive subcutaneous dissection than conventional open thyroidectomy, robotic thyroidectomy does not result in more postoperative pain or use of analgesic when compared with open thyroidectomy.