Initial experience using robot- assisted transaxillary thyroidectomy for Graves’ disease

Kandil, Emad; Noureldine, Salem I.; Khalek, Mohamed Abdel; Alrasheedi, Saud; Aslam, Rizwan; Friedlander, Paul; Holsinger, F. Christopher; Bellows, Charles F.

doi:10.1016/j.jviscsurg.2011.10.002

Cited by 27 publications

(25 citation statements)

References 26 publications

(38 reference statements)

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“…The utility of a robotic surgical approach to the management of Graves thyroiditis is less clear as it was considered a contraindication for surgery in several of the initial clinical studies. Kandil et al [42] reported their findings on a group of five patients undergoing GTA with total thyroidectomy for Graves disease. They were successful in performing the procedure robotically and had no reported post-operative complications.…”

Section: Thyroiditismentioning

confidence: 99%

Robotic Thyroid Surgery

Wharry

Stang

2012

Curr Surg Rep

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While thyroid surgery has been performed safely for nearly a century, the societal desire for a smaller and less visible surgical incision and consequent neck wound have become increasingly important for some patients. Within the last 5 years, thyroid surgical methods have been adapted by several groups to utilize robotic platform technology with the goal of achieving safe resection of the thyroid gland without a visible neck blemish. We review the currently published data regarding the use of surgical robotic platforms to perform remote access thyroid surgery. In particular, the currently described approaches, outcomes, complication profile, learning curve, and cost are examined. We also discuss the utility of the approach in populations of special interest to the endocrine surgeon, and a rational framework for adoption of the technology among surgeons interested in adding this technique to their armamentarium.

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Section: Thyroiditismentioning

confidence: 99%

Robotic Thyroid Surgery

Wharry

Stang

2012

Curr Surg Rep

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“…Endoscopic approaches are not recommended due to difficulties in controlling bleeding [23,37]. In a series of 5 robotic subtotal thyroidectomies for Graves' disease, there were no conversions to open or endoscopic techniques and no postoperative complications (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In a series of 5 robotic subtotal thyroidectomies for Graves' disease, there were no conversions to open or endoscopic techniques and no postoperative complications (e.g. bleeding, hypocalcemia and vocal cord palsy) [23]. Importantly, the case series cited lower intraoperative blood loss than with endoscopic and open techniques, attributed to the excellent surgical field view and precise movements when using the robot [23].…”

Section: Discussionmentioning

confidence: 99%

“…bleeding, hypocalcemia and vocal cord palsy) [23]. Importantly, the case series cited lower intraoperative blood loss than with endoscopic and open techniques, attributed to the excellent surgical field view and precise movements when using the robot [23]. This suggests that the robotic approach is feasible in patients with Graves' disease and should be looked upon as an alternative to traditional open or endoscopic techniques.…”

Section: Discussionmentioning

confidence: 99%

“…The medial border is the vertical line from the sternal notch to the midline of the thyroid [23], the inferior border of the dissection is a transverse line from the sternal notch to the ipsilateral axilla and the superior border is an oblique line from the thyrohyoid membrane drawn (at 60° with respect to the midline) to the ipsilateral axilla [23]. The vertical axillary incision is marked by the intersection of the superior and inferior borders of the dissection with the anterior axillary fold.…”

Section: Methodsmentioning

confidence: 99%

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Indications for the Gasless Transaxillary Robotic Approach to Thyroid Surgery: Experience of Forty-Seven Procedures at the American Hospital of Paris

Aïdan¹,

Pickburn²,

Monpeyssen³

et al. 2013

Eur Thyroid J

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Background: Thyroid surgery is in a state of evolution from traditional open approaches to novel robotic techniques. The gasless transaxillary approach to thyroid surgery is effective in the management of thyroid cancer, and complications after robotic thyroidectomy are no higher than experienced after open or endoscopic techniques. The transaxillary robotic approach also avoids an anterior neck scar. This paper presents what the authors believe to be the largest cohort of patients reported in Europe undergoing gasless transaxillary robotic thyroid surgery, with the aim of defining the indications for this procedure. Methods: Forty-six patients underwent robotic thyroid surgery via the transaxillary approach and were enrolled in this study between March 2010 and September 2012. All patients were operated on by one surgeon at one clinical center. Reviewed data included patient characteristics, pathological characteristics, extent of surgery and postoperative complications. The mean follow-up time was 7.29 months. Results: Forty-six patients underwent 47 procedures, the average age of the patients was 43 years and the male to female ratio was 1:22. Undertaken were 30 lobectomies, 3 subtotal thyroidectomies, 13 total thyroidectomies and 1 totalization. One case was converted to an open procedure. The ratio of malignant to benign disease was 1:6.67 (6:40 cases) and analysis of the surgical specimens showed 6 follicular lesions, 24 follicular adenomas, 3 colloid lesions, 1 case of thyroiditis/lymphatic lesion, 3 adenomatoid lesions, 3 oncocytic adenomas, 3 papillary cancers and 3 microcapillary cancers. The overall average size of an individual specimen removed was 45.40 ± 28.95 cm³ (range 5-160, n = 47) and the average largest diameter of the lesion removed was 3.72 ± 0.95 cm (range 1.4-6.0, n = 47). Postoperatively, there were 5 recurrent laryngeal nerve injuries (4 transient), 2 transient brachial plexopathies, 1 case of postoperative dysphagia and 1 of collection of blood at the site of surgery. There were no cases of disease recurrence at follow-up. Conclusions: The gasless robotic transaxillary approach to thyroid surgery has been predicted to become a standard technique. It has been shown to be efficacious in the management of thyroid cancer with lateral neck metastases; however, more data relating to oncological safety in long-term follow-up is required. This intervention is also appropriate for benign thyroid disease including Graves' disease. To achieve consistently successful results, careful patient selection is fundamental in terms of patient characteristics and the anatomical aspects of the lesion. This is especially important with a geographical expansion to include North America and Europe. The excellent cosmetic results of this procedure make it ideal for patients who have esthetic concerns regarding particular difficulties with healing; however, in common with all new surgical procedures, further evidence must be sought to confirm its indications over time.

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