Robot-Assisted Endoscopic Thyroidectomy for Thyroid Malignancies Using a Gasless Transaxillary Approach

Kang, Sang–Wook; Jeong, Jong Ju; Nam, Kee Hyun; Chang, Hang Seok; Chung, Woong Youn; Park, Cheong Soo

doi:10.1016/j.jamcollsurg.2009.05.003

Cited by 182 publications

(182 citation statements)

References 23 publications

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“…The use of robot techniques is new in the field of thyroid surgery. The few studies that have examined robotic thyroidectomy have involved only a small number of patients in a single center [9,[11][12][13][14][15]. Although other reports have demonstrated the safety and feasibility of robotic thyroidectomy, the present work is the first multicenter study to investigate this approach specifically for thyroid carcinoma treatment.…”

Section: Discussionmentioning

confidence: 97%

“…The surgical techniques for robotic thyroidectomy with our approach have been described in detail elsewhere [11][12][13].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Using an axillary approach, endoscopic access is adequate for thyroid cancer surgery and provides a natural view as per open surgery. Use of the dual-channel endoscope, the robot controlling system, and articulating instruments means robotic surgery provides 3-D magnified visualization, tremor-free handling, and a better range of motion even in deep and narrow spaces [11][12][13].…”

mentioning

confidence: 99%

“…The few published studies in this field are relatively small [11][12][13][14]. Little is known regarding the efficacy and safety of this technique, especially during the time of its introduction into centers and during the surgeon ''learning'' phase.…”

mentioning

confidence: 99%

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Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

et al. 2010

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Objectives Robotic thyroidectomy and lymph node dissection is rapidly emerging as an alternative to conventional endoscopic thyroidectomy for thyroid carcinoma. Robot techniques incorporate the advantages of endoscopic procedures while overcoming some of the problems. We present the largest multi-institution clinical study of robotic thyroidectomy for thyroid carcinomas. The robotic thyroidectomy involved gasless transaxillary approach using the da Vinci surgical robot system. Methods We reviewed a database of 1,043 consecutive patients with low-risk differentiated thyroid carcinoma who underwent robotic thyroidectomy between October 2007 and August 2009. Operations were performed by five surgeons at four academic centers. We analyzed perioperative, clinical, and pathological data. Results The study involved 71 men and 972 women, with a mean age of 39 (range, 15-70) years. All operations were performed successfully without any need for conventional open or endoscopic conversion. There were 366 total thyroidectomies and 677 subtotal thyroidectomies with cervical lymph node dissection. The mean overall operation time and console time were 132.4 and 63.9 min, respectively. There were ten (1%) major postoperative morbidities. The mean tumor size was 0.8 (range, 0.1-6.0) cm, and the mean number of retrieved central lymph nodes was 5.1 ± 3.8 (range, 0-26). The mean postoperative hospital stay was 2.9 (range, 1-8) days. Conclusions Robotic thyroidectomy using gasless transaxillary method was feasible, safe, and provided good outcomes for patients with differentiated thyroid carcinoma. Robotic technology overcame some technical limitations associated with conventional endoscopy.

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Section: Discussionmentioning

confidence: 97%

“…The surgical techniques for robotic thyroidectomy with our approach have been described in detail elsewhere [11][12][13].…”

Section: Surgical Techniquementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

et al. 2010

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“…Various remote access surgical methods have been developed to avoid cosmetically undesirable scars, with bilateral axillo-breast approach (BABA) thyroid surgery being one of the most popular. 2,3 In BABA as in OT, the patient is placed in the supine position with neck extension, followed by two circumareolar incisions (1.2 and 0.8 cm in size) and two 0.8 cm-sized axillary incisions. The 1.2 cm-sized incision is used for the camera port, and the three 0.8 cm-sized ports are used for the passage of surgical instruments.…”

Section: Introductionmentioning

confidence: 99%

Oncoplastic Thyroid Surgery Using A Bilateral Axillo-Breast Approach

Seong

Chai

et al. 2017

J Minim Invasive Surg

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Since the first use of the robot da Vinci system for thyroid surgery in 2007, robotic thyroidectomy (RT) via a bilateral axillo-breast approach (BABA) has become a popular surgical alternative for patients who wish to avoid scars on the neck. BABA RT provides excellent cosmetic satisfaction with surgical safety and oncologic completeness. Recently, the use of BABA RT has expanded beyond benign thyroid nodules and small-sized papillary thyroid carcinoma (PTC) to Graves' disease, relatively large PTCs, and PTC with lateral neck metastasis. Unfortunately, there are concerns about the use of this procedure for these additional indications. This review article summarizes postoperative outcomes of BABA RT for thyroid carcinoma, including quality of life, as well as expanding indications for BABA RT.

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Expense of Robotic Thyroidectomy

Broome¹,

Pomeroy²,

Solórzano³

2012

Arch Surg

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The cost of robotic thyroidectomy (RT) is significantly higher than that of standard open thyroidectomy (ST). Design: A retrospective cost analysis of ST was compared with a projected cost analysis of RT using institution-specific data. Setting: Endocrine surgery division at an academic center. Participants: Standard open thyroidectomy data from 2 high-volume endocrine surgeons vs published variables from high-volume RT surgeons. Main Outcome Measures: A cost analysis was performed for ST (Current Procedural Technology code 60240). The cost of RT was estimated as operative time plus anesthesia fees plus consumables plus the robotic system (da Vinci Surgical System; Intuitive Surgical, Inc). Institution-specific data were collected for ST, and only those costs that varied between ST and RT were included in the analysis. The mean operative time for ST was based on data from 2 high-volume endocrine surgeons at our institution. The RT operative data were extracted from published series of high-volume RT surgeons. Results: The relative costs calculated were $2668 for ST vs $5795 for RT. This represents a 217% increased cost of RT compared with ST. The mean operative times were 113 minutes for ST vs 137 minutes for RT. Conclusions: Technologic advances are paramount in providing the best medical care for patients. This progress must be tempered by a rational, open discussion about the costs of these advancements. Only then can the proposed benefits of a new technology be weighed accurately against the overall societal cost. Surgeons need to be aware of the cost of their technologic choices and the burdens that those place on limited resources.

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Robot-Assisted Endoscopic Thyroidectomy for Thyroid Malignancies Using a Gasless Transaxillary Approach

Cited by 182 publications

References 23 publications

Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

Oncoplastic Thyroid Surgery Using A Bilateral Axillo-Breast Approach

Expense of Robotic Thyroidectomy

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