Robotic versus endoscopic transoral thyroidectomy in papillary thyroid cancer: A comparative analysis of surgical outcomes in 240 consecutive patients

Transoral vestibular robotic thyroidectomy in pediatric thyroid disease: 5 case reports

BACKGROUND

The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach in pediatric patients has been clinically proven, and its cosmetic results have been recognized by children and their families. However, there are no reports on using transoral robotic in pediatric thyroid surgery. In this study, we report the experience of 5 cases of transoral vestibular robotic thyroidectomy in treating of thyroid disease in children.

PATIENTS AND METHODS

Retrospective analysis of clinical data of five children who underwent robotic thyroid surgery via the TOVRT in our hospital from February 2021 to April 2023, including operation time, tumor diameter, postoperative hospitalization time, and surgical complications. All five patients were operated on by the same team, and the postoperative pathological results were all follicular adenoma of thyroid. The children had a strong desire for cosmetic surgery, and their families voluntarily chose the robotic surgical system for their surgery.

RESULTS

All five patients underwent unilateral thyroid lobectomy without conversion to open surgery. All patients were female, with a mean BMI of (19.63 ± 1.79) kg/m2 and the mean age was (14.40 ± 2.33) years. The average operation time was (52.00 ± 5.10) mins, the average tumor diameter was (41.60 ± 8.41) mm, and the average postoperative hospital stay was (3.60 ± 0.49) days. There were no complications such as hypoparathyroidism, recurrent laryngeal nerve injury, genioglossal nerve injury, or skin necrosis.

CONCLUSION

The transoral vestibular robotic thyroidectomy is safe and feasible, providing a new treatment option for pediatric thyroid diseases that require surgical treatment.

No closure of the linea alba cervicalis reduces complications in endoscopic thyroidectomy

The benefits of not suturing the linea alba cervicalis and using negative pressure wound therapy after endoscopic thyroidectomy have attracted increasing attention. Therefore, this study aims to determine whether the non-closure of the linea alba cervicalis after endoscopic thyroidectomy can significantly reduce postoperative complications and evaluate the application of NPWT to prevent cavity-related complications. A retrospective analysis was performed. 142 patients were enrolled and divided into two groups, including 71 individuals in the improvement group (no suture of the linea alba cervicalis) and 71 in the conventional group (suture the linea alba cervicalis). Then, the general clinical data and operative indicators were analyzed and compared between the two groups using SPSS 26.0 software. Statistical significance was recognized with P < 0.05. The improvement group showed a lower incidence of neck edema (3/71,4.2% vs. 10/71,14.1%) and a lower score on the Visual Analogue Scale (VAS) 5 days after the operation (3 ± 1.2 vs. 4 ± 1.3) between the two groups (P < 0.05), and there is no significant difference in the overall incidence of postoperative complications between the two groups (P>0.05). No closure of the linea alba cervicalis is safe and feasible after endoscopic thyroidectomy via chest-breast approach, with significantly less incidence of neck edema and lower neck discomfort. In addition, NPWT, providing a novel tool to reduce the occurrence of cavity-related complications in current clinical practice, can be used in whether or not to suture the linea alba cervicalis, which is safe and effective.

Comparison of postoperative pain between transoral and conventional thyroidectomy: a propensity score-matched analysis

BACKGROUND

The extent of postoperative pain following transoral thyroidectomy is not well-understood and remains a subject of debate. This study aims to analyze and compare postoperative pain levels between patients undergoing transoral and conventional transcervical thyroidectomy.

METHODS

A prospective evaluation on postoperative pain was conducted in 310 patients undergoing conventional thyroidectomy and 194 undergoing transoral thyroidectomy. Pain levels were evaluated using the numerical rating scale (NRS, ranging from 0 to 10) through preoperative and postoperative questionnaires at specified time points: 1, 3, and 6 days, and 1 and 3 months following surgery. Propensity score-matched analysis was carried out based on six covariates: sex, age, body mass index, extent of thyroidectomy, tumor size, and central neck dissection.

RESULTS

After propensity score matching based on the six covariates, 121 patient pairs were identified from each group. Within this matched cohort, postoperative pain scores significantly worsened 1 day after surgery but showed progressive recovery up to 3 months post-surgery in both groups. The transoral group exhibited higher postoperative pain scores than the conventional group from day 1 (4.43 ± 2.6 vs. 3.11 ± 2.5, p < 0.001) to day 6 (1.76 ± 1.9 vs. 1.13 ± 1.6, p = 0.016) post-surgery, with no significant difference noted at 1 month. Among transoral procedures, pain scores were significantly higher for the endoscopic approach compared to the robotic approach on days 1 (5.52 ± 2.3 vs. 4.29 ± 2.3, p = 0.028) and 3 (3.52 ± 2.5 vs. 2.64 ± 2.0, p = 0.047) post-surgery.

CONCLUSIONS

Postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy up to 6 days post-surgery. Within the transoral group, the robotic procedure resulted in lower pain levels than the endoscopic approach during the early postoperative period.

Comparison of surgical outcomes of transoral robotic and endoscopic thyroidectomy: A systematic review and network meta-analysis

This study aimed to compare surgical outcomes of transoral robotic thyroidectomy (TORT) and transoral endoscopic thyroidectomy vestibular approach (TOETVA), concurrently compared with conventional transcervical thyroidectomy (CTT). A network meta-analysis, comprising 23 studies, was performed in this study. The operative time of the CTT group was significantly shorter than that of the TOETVA and TORT groups. The hospital stay of the TOETVA group was significantly longer than that of the CTT group. Rates of transient recurrent laryngeal nerve palsy and total complications were higher in association with TOETVA than with TORT. No significant differences were found between the three groups in intraoperative blood loss, retrieved lymph nodes, postoperative pain, and other complications. Cosmetic satisfaction was significantly superior with TORT and TOETVA than with CTT. Compared with CTT, TOETVA and TORT showed superior cosmesis but no significant difference in surgical outcomes except for operative time and hospital stay.

Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases.

MATERIALS AND METHODS

Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications.

RESULTS

A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001).

CONCLUSION

For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.

Initial Clinical Application of Enhanced Recovery After Transoral Robotic Thyroidectomy

Background: The enhanced recovery after surgery (ERAS) protocol has been widely adopted across various surgical subspecialties. Transoral robotic thyroidectomy (TORT) has grown in popularity in the past decade. Therefore, this study aimed to discuss the initial application of ERAS in TORT. Methods: We retrospectively analyzed the clinical data of 95 patients who had undergone TORT in our department from April 2020 to March 2022. All patients were treated using the ERAS protocol. Results: TORT was successfully performed in all 95 patients. Postoperative histopathological examination revealed papillary carcinoma. The average operative time, hemorrhage volume, length of postoperative stay, and pain score (24 hours after surgery) were 227.32 ± 44.37 minutes, 35.81 ± 23.45 mL, 1.37 ± 0.62 days, and 2.11 ± 0.54, respectively. Sixty patients received an analgesia pump, with no significant difference in pain scores between the patients with and without the pump (P > .05). Eight patients experienced transient mandibular numbness, and two experienced transient hoarseness postoperatively. Of the 24 cases of total thyroidectomy/bilateral subtotal thyroidectomy (ST) or lobectomy with isthmusectomy plus contralateral ST patients, 8 developed transient hypoparathyroidism. No common complications, such as incision infection, hematoma/effusion formation, coughing while drinking, or permanent hoarseness/hypocalcemia, were reported. Conclusion: Our initial outcomes demonstrate that implementing an ERAS protocol in TORT is safe and feasible.

Recent Advances in the Surgical Management of Thyroid Cancer

A growing incidence of differentiated thyroid cancer (DTC) has been reported in most developed countries, corresponding mainly to incidentally discovered small papillary thyroid carcinomas. Given the excellent prognosis of most patients with DTC, optimal therapeutic management, minimizing complications, and preserving patient quality of life are essential. Thyroid surgery has a central role in both the diagnosis, staging, and treatment of patients with DTC. Thyroid surgery should be integrated into the global and multidisciplinary management of patients with DTC. However, the optimal surgical management of DTC patients is still controversial. In this review article, we discuss the recent advances and current debates in DTC surgery, including preoperative molecular testing, risk stratification, the extent of thyroid surgery, innovative surgical tools, and new surgical approaches.

Three-port transoral robotic thyroidectomy without axillary incision: A preliminary report on a case series from Vietnam

BACKGROUND

Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. Here, we present our preliminary data from the initial 5 consecutive patients to explore the feasibility of three-port TORT without axillary incision.

METHODS

From August 2022 to December 2022, we performed TORT using three ports via the da Vinci Xi system with three robotic arms.

RESULTS

All 5 patients had cT1aN0M0 papillary thyroid carcinomas with a mean tumour size of 6 mm. All patients underwent lobectomy with ipsilateral central neck dissection. The mean surgical time was 170 ± 15,8 min; the average length of hospital stay is 4.2 days. The number of retrieved central lymph nodes was 4.2 ± 0.8. All patients were discharged uneventfully without complications and completely satisfied with the cosmetic results.

CONCLUSIONS

TORT is feasible and safe when performed on carefully selected patients by experienced surgeons.