Robotic Surgery for Thyroid Disease

Abstract

Robotic surgery is an innovation in thyroid surgery that may compensate for the drawbacks of conventional endoscopic surgery. A surgical robot provides strong advantages, including three-dimensional imaging, motion scaling, tremor elimination, and additional degrees of freedom. We review here recent adaptations, experience and applications of robotics in thyroid surgery. Robotic thyroid surgeries include thyroid lobectomy, total thyroidectomy, central compartment neck dissection, and radical neck dissection for benign and malignant thyroid diseases. Most of the current literature consists of case series of robotic thyroidectomies. Recent retrospective and prospective analyses have evaluated the safety and oncologic efficacy of robotic surgery for thyroid cancer. Although robotic thyroid surgery is often associated with longer operation times than conventional open surgery, robotic techniques have shown similar or superior levels of surgical completeness and safety compared with conventional open or endoscopic surgery. Compared to open thyroidectomy, robotic thyroidectomy has been associated with several quality-of-life benefits, including excellent cosmetic results, reduced neck pain and sensory changes, and decreased voice and swallowing discomfort after surgery. For surgeons, robotic surgery has improved ergonomics and has a shorter learning curve than open or endoscopic surgery. The advantages of robotic thyroid surgery over conventional surgery suggest that robotic thyroidectomy with or without neck dissection may become the preferred surgical option for thyroid diseases. Robotic thyroid surgery will likely continue to develop as more endocrine and head-and-neck surgeons are trained and more patients seek this newly developed surgical option.

Safe implementation of retroauricular robotic and endoscopic neck surgery in South America

“…Last year, we published two papers (41,42) (another three are currently in the publication process) and we presented at more than 15 congresses on this subject. However, this is not an easy task as the local medical journals have low impact factors and most of our data represents an initial reproduction of a much larger experience already well described in the literature, especially by Korean authors (17,25,26,28,30,32,43,44).…”

The Surgical Robot: Applications and Advantages in General Surgery

“…On the topic of thyroidectomy, the robotic technique has been found to be very advantageous to the surgeons due to superior ergonomics when compared to the endoscopic approach, in addition to the fact that the learning curve is easier to master with the surgical robot [73]. Another concept was introduced by a group that reported on their initial experience with robotic thyroidectomy in 2011, which was the fact that the robotic technique eliminates the need to have an assistant in spite of an increased procedure time [74].…”

Overview of robotic thyroidectomy

“…After general anesthesia induction, the patient is in the supine position with slight extension of the neck (6,29,30). This neck extension can be achieved by using either a shoulder roll or by using a thyroid pillow which also offers additional supports to the upper back and scapula (29).…”

“…The incision is made using a 15 blade, and the subcutaneous flap is raised using electrocautery. It is Transient VC palsy [5], permanent VC palsy [3], Temporary hypoparathyroidism [12], temporary MM nerve injury [5], earlobe numbness [6], seroma [21], hematoma [2], chyle leak [1], skin flap ischemia [2] TT or less: 6; TT + MRND: 10 PTC, papillary thyroid cancer; FTC, follicular thyroid cancer; HT, hemithyroidectomy; TT, total thyroidectomy; MRND, modified radical neck dissection. A B very important to preserve the fascia overlying the pectoralis major muscle to prevent postoperative adhesions which may lead to increased discomfort and pain over the chest area.…”

“…Using a robotic system helped to overcome some of the limitations of the endoscopic procedures such as reduced range of motion, and impaired eye-hand coordination (while relying on an unstable 2-dimentional view) (3,(5)(6)(7). Because of this, robotic thyroidectomy has become increasingly popular around the world (8-10) attracting both surgeons and patients searching for new and innovative procedures and allowing for the removal of thyroid glands with a superior cosmetic result (4,6,8) when compared to the conventional open thyroidectomy procedures. Many studies have described the safety of the remote-access robotic thyroidectomy procedures and have demonstrated comparable oncologic outcomes between the robotic and open conventional thyroidectomy (11)(12)(13)(14).…”