Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies

Kim, Min Jhi; Nam, Kee Hyun; Lee, Seul Gi; Choi, Jun Shik; Kim, Tae Hyung; Lee, Cho Rok; Lee, Jandee; Kang, Sang–Wook; Jeong, Jong Ju; Chung, Woong Youn

doi:10.1007/s00268-017-4209-y

Cited by 65 publications

(61 citation statements)

References 44 publications

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“…However, the incidence of transient recurrent laryngeal nerve injury in this study may be underestimated, because only the patients with obvious voice changes after surgery were examined by laryngoscopy. It was reported that the incidence of transient and permanent hypoparathyroidism after robotic thyroid surgery was 14% to 37% and 0 to 4.8% [26][27][28], 36.1% and 7.0% after total thyroidectomy plus unilateral central lymph node dissection, and 51.9% and 16.2% after total thyroidectomy and bilateral central lymph node dissection, respectively [29]. In this study, the incidence of transient and permanent hypoparathyroidism was 18.4% (39/212) and 1.9% (4/212) after total thyroidectomy and unilateral central node dissection, 22.2% (6/27) and 3.7% (1/27) after total thyroidectomy and bilateral central node dissection, respectively (lower than most of the results reported in the literature).…”

Section: Discussionmentioning

confidence: 99%

Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon

Liu¹,

Zhang²,

Qi³

et al. 2019

J. Cancer

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Objective: To investigate the efficacy and safety of da Vinci robot-assisted thyroidectomy via an unilateral axilla-bilateral areola (UABA) approach. Methods: The clinical data of 500 patients undergoing robotic thyroidectomy via an UABA approach from July 2014 to April 2018 were retrospectively analyzed. All 500 patients were operated on by the same surgeon and divided into two groups by the time sequence. The efficacy and complications were compared between the two groups. Results: Robotic thyroidectomy via an UABA approach was performed successfully in 500 cases, including 196 cases of benign thyroid diseases with a lesion diameter of 3.1 ± 1.3 cm (0.4-8.2 cm) and 304 cases of thyroid cancer with a tumor diameter of 1.2 ± 0.7 cm (0.4-4.4 cm). Surgical procedures included unilateral lobectomy and total thyroidectomy with or without central lymph node dissection. Among the 500 patients, 9 (1.8%) had transient recurrent laryngeal nerve injury, 1 (0.2%) had permanent unilateral recurrent laryngeal nerve injury, 12 (2.4%) had subcutaneous hemorrhage of the trajectory area, and 6 (1.2%) had subcutaneous infection of the trajectory area after surgery. Among 239 thyroid cancer patients undergoing total thyroidectomy, 45 (18.8%) had transient hypoparathyroidism and 5 (2.1%) had permanent hypoparathyroidism. The incidence of permanent hypoparathyroidism was 1.9% (4/212) among the patients undergoing total thyroidectomy plus unilateral central lymph node dissection, and 3.7% (1/27) among the patients undergoing total thyroidectomy plus bilateral central lymph node dissection. During the follow-up of median 17 months, all patients were satisfied with postoperative appearance of the neck and no structural recurrence or metastases occurred. There was no significant difference in efficacy between the two groups (P > 0.05), while the complication rate in phase 2 was significantly lower than that in phase 1 (P < 0.05) as the surgeon became more proficient in the UABA approach. Conclusion: Robotic thyroidectomy via an UABA approach is simple, safe, and minimally invasive, suitable for radical resection of large benign tumors and early thyroid cancer and central lymph node dissection.

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Section: Discussionmentioning

confidence: 99%

Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon

Liu¹,

Zhang²,

Qi³

et al. 2019

J. Cancer

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“…On the basis of the development and accumulated experience of many surgical methods, we extended the indication for the robotic system to more advanced cases. 26 27 Current studies have reported surgical outcomes comparable to those of conventional procedures. 28 29 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Robotic Procedures Performed Using the da Vinci Robotic Surgical System at a Single Institute in Korea: Experience with 10000 Cases

et al. 2018

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PurposeTo evaluate the efficacy and safety of robotic procedures performed using the da Vinci Robotic Surgical System at a single institute.Materials and MethodsWe analyzed all robotic procedures performed at Severance Hospital, Yonsei University Health System (Seoul, Korea). Reliability and mortality rates of the robotic surgeries were also investigated.ResultsFrom July 2005 to December 2013, 10267 da Vinci robotic procedures were performed in seven different departments by 47 surgeons at our institute. There were 5641 cases (54.9%) of general surgery, including endocrine (38.0%), upper (7.7%) and lower gastrointestinal tract (7.5%), hepato-biliary and pancreatic (1.2%), and pediatric (0.6%) surgeries. Urologic surgery (33.0%) was the second most common, followed by otorhinolaryngologic (7.0%), obstetric and gynecologic (3.2%), thoracic (1.5%), cardiac (0.3%), and neurosurgery (0.1%). Thyroid (40.8%) and prostate (27.4%) procedures accounted for more than half of all surgeries, followed by stomach (7.6%), colorectal (7.5%), kidney and ureter (5.1%), head and neck (4.0%), uterus (3.2%), thoracic (1.5%), and other (2.9%) surgeries. Most surgeries (94.5%) were performed for malignancies. General and urologic surgeries rapidly increased after 2005, whereas others increased slowly. Thyroid and prostate surgeries increased rapidly after 2007. Surgeries for benign conditions accounted for a small portion of all procedures, although the numbers thereof have been steadily increasing. System malfunctions and failures were reported in 185 (1.8%) cases. Mortality related to robotic surgery was observed for 12 (0.12%) cases.ConclusionRobotic surgeries have increased steadily at our institution. The da Vinci Robotic Surgical System is effective and safe for use during surgery.

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“…Follow-up duration of TOETVA is shorter than that of other remote access endoscopic or robotic surgery methods. To assure the oncological safety of TOETVA, it will be necessary to build up a prospectively recruited large-scale cohort to check Thyroglobulin (TG) or thyroid stimulating hormone stimulated thyroglobulin (off-TG) levels after total thyroidectomy, as used in previous transaxillary and BABA methods [ 26 27 28 ]. Another issue is surgical site infection.…”

Section: Discussionmentioning

confidence: 99%

Transoral endoscopic surgery for papillary thyroid carcinoma: initial experiences of a single surgeon in South Korea

Yoon

Kim

et al. 2018

Ann Surg Treat Res

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PurposeThe transoral endoscopic thyroid surgery vestibular approach (TOETVA) is one of the newest techniques which do not result in an anterior neck scar. We report herein our initial experience with TOETVA and its short-term outcomes in patients with papillary thyroid carcinoma (PTC).MethodsThis case series consisted of all consecutive patients who underwent TOETVA in our institution between August 2016 and June 2017. Indications for TOETVA were an fine needle aspiration-confirmed PTC or follicular neoplasm, an intrathyroidal tumor with a diameter of less than 2 cm, and no clinical evidence of central or lateral lymph node metastasis. A total of 20 patients underwent TOETVA and we retrospectively reviewed clinicopathologic data and short-term postoperative outcomes.ResultsAmong the 20 TOETVA cases, 7 were total thyroidectomy, 12 were lobectomy and 1 was wide isthmusectomy. Mean age was 50.8 years and mean operation time was 152 ± 51.4 minutes. Tumor size ranged from 0.2–1.4 cm and the mean size of harvested central lymph nodes was 2.8 (range, 0–10). Neither mental nerve injury nor surgical site infection occurred. One patient had transient vocal cord palsy and 1 patient developed a neck seroma. Among 7 total thyroidectomy patients, 3 patients developed transient hypocalcemia.ConclusionTransoral thyroid surgery could be an alternative surgical option for some PTC patients.

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Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies

Cited by 65 publications

References 44 publications

Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon

Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon

Efficacy and Safety of Robotic Procedures Performed Using the da Vinci Robotic Surgical System at a Single Institute in Korea: Experience with 10000 Cases

Transoral endoscopic surgery for papillary thyroid carcinoma: initial experiences of a single surgeon in South Korea

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