Comparison of Surgical Outcomes between Robotic Transaxillary and Conventional Open Thyroidectomy in Pediatric Thyroid Cancer

Abstract

Thyroid cancer in children is very uncommon. For pediatric thyroid cancer, robotic surgery has served as a minimally invasive surgical alternative to conventional open surgery. Our study aimed to evaluate the results of robotic versus open surgical treatment for patients with thyroid cancer younger than 20 years of age at the time of diagnosis. This retrospective review included 161 pediatric patients who underwent robotic transaxillary or conventional open thyroidectomy at our institution from 2008 to 2019. Of these patients, 99 comprised the robotic group and 62 the open group. Patient demographics, surgical outcomes, and disease-free survival rates were compared between the two groups. Patients in the open group were more likely to have advanced stage diseases with a larger tumor size and higher tumor-node-metastasis stage than those in the robotic group. Operation time and follow-up period were similar in both groups. Patients in the robotic group had a lower rate of postoperative complications and a shorter length of hospital stay, but they also had a lower average number of retrieved central lymph nodes. However, there were no significant between group differences in recurrence rates and disease-free survival. In the hands of an experienced surgeon, robotic thyroidectomy is a feasible and safe option for pediatric patients.

Efficacy of Modified Nonpneumatic Transaxillary Approach in the Treatment of Thyroid Cancer and Its Effect on Immune Function and Parathyroid Function

“…Its anatomical structure is very complex, and there are many nerves, blood vessels, and capsule tissues around it [ 11 ]. Therefore, if it is operated improperly during the operation, the adjacent tissues and parathyroid will be injured by mistake, resulting in postoperative epileptic seizure, limb numbness, muscle spasm, and agitation [ 12 , 13 ]. Parathyroid gland mainly secretes PTH, which is involved in the regulation of calcium and phosphate metabolism.…”

Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review

“…A literature review of eighteen articles dealing with thyroid surgery in paediatric population is shown in Table 3 [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most studies (18) included in our literature review were retrospective studies.…”

“…Study period varied from 1 year [ 17 ] to 18 years [ 22 ]. Studies with the most patients were those in which partial or total thyroidectomy was usually performed [ 12 , 13 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], while fewer patients were included in studies that analysed robotic trans-axillary and retro-auricular approach [ 14 ] or transoral endoscopic thyroidectomy via vestibular approach [ 17 ]. The most common complication in all operations was hypocalcaemia due to incidental parathyroidectomy and recurrent laryngeal nerve injury.…”

Laryngeal Neural Monitoring during Pediatric Thyroid Cancer Surgery—Is Transcartilage Recording a Preferable Method?

“…As an alternative option of TC-IONM without elevating the skin on the thyroid cartilage for minimally invasive surgery or even remote surgery, in these scenarios, percutaneous TC-IONM using long needle electrodes showed great potential [29,31]. Remote thyroidectomy includes endoscopic [49] and robotic [50] approaches. These had been reported as emerging surgical procedures in the pediatric population.…”