A Propensity Score‐matched Comparison Study of Surgical Outcomes in Patients with Differentiated Thyroid Cancer After Robotic Versus Open Total Thyroidectomy

Abstract

Introduction The aim of this study, from a surgical, oncological, and functional perspective, was to identify whether bilateral axillo‐breast approach robotic total thyroidectomy (RTT) for differentiated thyroid cancer (DTC) has different surgical outcomes compared to open total thyroidectomy (OTT). Methods Initially, 796 patients who underwent total thyroidectomy were primarily reviewed and 178 who were ineligible for analysis were excluded. Propensity score matching analysis adjusted for clinicopathological characteristics (sex, age, body mass index, extent of central node dissection, tumor size, extrathyroidal extension, and thyroiditis) was conducted, with 246 patients in the OTT group matched with 123 patients in the RTT group. Results There were no significant differences in surgical outcomes in terms of surgical safety and oncological safety between the OTT and RTT groups, except in mean operation times (123.51 ± 32.63 vs. 198.39 ± 37.93 min, respectively; P < 0.001). However, the median parathyroid and laryngeal function recovery times were shorter in the RTT group than in the OTT group [88 ± 33.09 (95% CI: 23.148–152.852) vs. 100 ± 16.20 (95% CI: 68.242–131.768) days; P = 0.044 and 87 ± 32.40 (95% CI: 23.489–150.511) vs. 118 ± 49.50 (95% CI: 20.985–215.015) days; P = 0.002]. Conclusions The recovery times of laryngeal and parathyroid function were significantly shorter in RTT patients than in OTT patients for DTC. To verify a definitive conclusion about the superiority of robotic total thyroidectomy in terms of parathyroid and laryngeal function recovery, further studies may be necessary.

Quality of life and surgical outcome of ABBA versus EndoCATS endoscopic thyroid surgery: a single center experience

“…One is that we reported the outcome of only a small number of patients in a highly selected collective from a single center. However, other groups also report only a small number of cases with a low degree of evidence [8,10,12,18,20,21,25,[39][40][41][42]. Furthermore, there is a bias due to patient selection for either one of the endoscopic or open procedures, as the EndoCATS approach can only be used for unilateral resections, whereas the ABBA technique is suitable for uni-and bilateral resections but only in female patients.…”

“…Other groups mostly in the Asian countries have been using endoscopic and robotic techniques in treatment of differentiated thyroid cancer for years with excellent outcomes. They do not only perform thyroidectomies but also central and lateral lymph node dissections with similar outcomes compared to conventional open procedures regarding lymph node retrieval and long-term patient survival [ 25 , 28 , 38 , 40 , 41 ]. Altogether, the endoscopic techniques turned out to be safe and effective not only in benign thyroid disorders, but also for limited thyroid malignancies.…”

“…Neither in Germany nor internationally, the remote access procedures have not yet been included in the guidelines for the treatment of at least differentiated thyroid cancer. In Asian countries, however, endoscopic techniques are already well established not only for the radical resection of cancer but also for central as well as selective lateral lymph node dissection in thyroid cancer patients [ 11 , 25 , 28 , 29 , 38 , 40 , 41 , 50 ]. In Europe there have been some first successful experiences with the transaxillary robotic approach in selected patients with differentiated thyroid cancer for thyroid resection and central lymph node dissection [ 51 ].…”

Unilateral axilla-bilateral areola approach for thyroidectomy by da Vinci robot vs. open surgery in thyroid cancer: a retrospective observational study

“…The da Vinci robot system has been used for surgical treatment of thyroid cancer (7,14) due to its high-definition 3D field of view, remote control operation that filters hand shaking, and internal joint instruments (11,12). However, whether robotic surgery is superior to conventional open surgery is still controversial because of its high cost and clinical outcomes (8,12,13,17,18). To our acknowledgement, this is the first study to compare UABA robotic surgery with open surgery, and our results indicate that UABA robotic thyroidectomy can preserve the neck appearance and effectively reduce hypoparathyroidism by SMCD.…”

“…As one of the advanced endoscopic systems, the da Vinci robot has the advantages of 3D high-definition vision and a remote control that filters operator shaking; it also has flexible internal joints with 7 degrees of freedom, which is more conducive to meticulous operation compared with conventional open surgery (5,6). Therefore, it has been widely used for thyroid surgery (7)(8)(9)(10). However, it is unclear whether robotic thyroid surgery is superior to open surgery in terms of efficacy and complications (10)(11)(12)(13).…”