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Bonati E, Mullineris B, Del Rio P, Loderer T, De Gennaro F, Esposito G, Menduni N, Pedrazzi G, Piccoli M. Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes. Updates Surg 2024; 76:573-587. [PMID: 38198118 DOI: 10.1007/s13304-023-01732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20 years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.
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Affiliation(s)
- Elena Bonati
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy.
| | - Barbara Mullineris
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Paolo Del Rio
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Tommaso Loderer
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Flavia De Gennaro
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Giuseppe Esposito
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Nunzia Menduni
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Micaela Piccoli
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
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Pace-Asciak P, Tufano RP. Future Directions in the Treatment of Thyroid and Parathyroid Disease. Otolaryngol Clin North Am 2024; 57:155-170. [PMID: 37634983 DOI: 10.1016/j.otc.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The surgical management of thyroid and parathyroid disease has evolved considerably since the era of Theodor Kocher. We review the current trends in thyroid and parathyroid surgery concerning robotic surgery for remote access, the use of parathyroid autofluorescence detection technology to aid in the prevention of hypocalcemia as well as the use of thermal ablation to target thyroid nodules in a minimally invasive way. We also discuss how artificial intelligence is being used to improve the workflow and diagnostics preoperatively as well as for intraoperative decision-making. We also discuss potential areas where future research may enhance outcomes.
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ralph P Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, USA
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Hays SB, Corvino G, Lorié BD, McMichael WV, Mehdi SA, Rieser C, Rojas AE, Hogg ME. Prince and princesses: The current status of robotic surgery in surgical oncology. J Surg Oncol 2024; 129:164-182. [PMID: 38031870 DOI: 10.1002/jso.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.
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Affiliation(s)
- Sarah B Hays
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Gaetano Corvino
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin D Lorié
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William V McMichael
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Syed A Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Caroline Rieser
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram E Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
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Yu DY, Chang YW, Ku D, Ko SY, Lee HY, Son GS. Robotic thyroidectomy using gas-insufflation one-step single-port transaxillary (GOSTA) approach. Surg Endosc 2023; 37:8861-8870. [PMID: 37749201 DOI: 10.1007/s00464-023-10435-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND We conducted this study to report our novel robotic thyroidectomy using gas-insufflation one-step single-port transaxillary (GOSTA) approach and compare it with a conventional transaxillary (CTA) approach using a retraction method for intraoperative and postoperative outcomes. METHODS We retrospectively analyzed 354 patients who underwent robotic thyroidectomy between January 2019 and April 2023. Of these patients, 143 underwent the procedure through the GOSTA approach, which involves a small incision of 3 cm along the axillary folds with both arms down and a gas-insufflation, from skin flap creation to the completion of thyroidectomy as a one-step single-port procedure without the need for a retractor. The remaining 211 patients underwent the CTA approach. We analyzed the GOSTA approach and compared the surgical outcomes of the GOSTA (n = 100) and CTA (n = 167) approaches in patients with differentiated thyroid cancer who underwent thyroid lobectomy. RESULTS Out of the 143 patients who underwent the GOSTA approach, 12 underwent total thyroidectomy and 9 underwent lateral neck lymph node dissection with total thyroidectomy. GOSTA-thyroid lobectomy was performed on 122 patients; of these, 100 were diagnosed with differentiated thyroid carcinoma. A comparative study with the CTA approach was only conducted in patients who underwent thyroid lobectomy. No significant differences were found in operative time, hospital stay, or complications between the two groups. CONCLUSIONS Despite proceeding in one-step with a single smaller incision, from skin flap creation to the completion of thyroidectomy, the GOSTA approach is as feasible and safe as the CTA approach. Additionally, the GOSTA approach allows for thyroidectomy without using a retractor and reduces the workload for the surgeon and assistants.
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Affiliation(s)
- Da Young Yu
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Chang
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, Republic of Korea.
| | - Dohoe Ku
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Yeon Ko
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Yoon Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gil Soo Son
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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Choi YS, Choi JH, Jeon MS, Yu MJ, Lee HM, Shin AY, Yi JW. First Experience of Single-Port Robotic Areolar Approach Thyroidectomy. Clin Exp Otorhinolaryngol 2023; 16:275-281. [PMID: 37475141 PMCID: PMC10471905 DOI: 10.21053/ceo.2023.00682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Numerous minimally invasive thyroidectomy techniques have been developed and are actively utilized in hospitals around the globe. Herein, we describe a recently developed minimally invasive thyroidectomy technique that employs the da Vinci SP, and we present the preliminary clinical outcomes of single-port robotic areolar thyroidectomy (SPRA). METHODS A 3-cm semi-circular incision on the right areola and a small 8-mm incision on the left areola were created. Using hydro-dissection and an advanced bipolar device, a subcutaneous skin flap was created, extending from the areola to the thyroid cartilage. The da Vinci SP was then inserted through the incision in the right areola. Between December 2022 and March 2023, 21 SPRA procedures were conducted. Patients' medical records and surgical videos were subsequently reviewed. RESULTS Lobectomy was performed in 17 patients, isthmectomy in 2 patients, and total thyroidectomy in 2 patients. The mean flap time was 14.9±4.2 minutes and the console time was 62.4±17.1 minutes. The mean tumor size was 0.89± 0.65 cm and the number of retrieved lymph nodes was 3.94±3.98 (range, 0-12). There were no observed instances of vocal cord palsy or hypoparathyroidism. CONCLUSION We successfully developed and performed the novel SPRA for the first time worldwide. Unlike other robotic surgery. METHODS SPRA is less invasive and leaves no visible scars. This technique employs a sophisticated single-port robotic device. However, to assess the efficacy of this method, we need to analyze more cases and conduct comparative studies in the near future.
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Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ji Hyun Choi
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Mi Sook Jeon
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Min Jung Yu
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hye Mi Lee
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ae Young Shin
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Altedlawi Albalawi IA, Mirghani HO. The quality of life after trans oral video-assisted thyroidectomy and cervical thyroidectomy: a systematic review and meta-analysis. Front Surg 2023; 10:1116473. [PMID: 37266003 PMCID: PMC10229877 DOI: 10.3389/fsurg.2023.1116473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Trans oral video-assisted thyroidectomy (TOVAT) is increasingly performed for cosmetic reasons. The quality of life after thyroidectomy is important for decision-making. This is the first meta-analysis to compare the quality of life among conventional transcervical thyroidectomies. This meta-analysis aimed to assess the same in the current literature. The authors systematically searched PubMed, Google Scholar, and EBSCO for relevant articles from the first published to December 4, 2022. The keywords endoscopic transoral via vestibular thyroidectomy, transcervical thyroidectomy, conventional thyroidectomy, scarless thyroidectomy, and quality of life were used. Out of the 482 studies retrieved, 27 full texts were reviewed, and only six fulfilled the inclusion and exclusion criteria. Patients with transoral thyroidectomy showed better quality of life that their counterparts who underwent transcervical thyroidectomy at 4-6 weeks following surgery, odd ratio, 2.26, 95% CI, 2.02-2.5, P-value <0.001. Substantial heterogeneity was observed, I2 for heterogeneity, 100%. The quality of life was better among patients who underwent the trans oral video-assisted thyroidectomy (TOVAT) compared to their counterparts with the conventional cervical approach (surgical questionnaire). All the components of the SF-36 quality of life questionnaire were better among TOVAT compared to the conventional approach except for social and general health components, which were equal between the two arms. Further multi-center studies with larger samples and controlling for pain and the surgical curve are needed.
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Affiliation(s)
| | - Hyder Osman Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
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Lee JH, Choi HJ, Woo JW, Jung EJ. Robotic versus endoscopic transoral thyroidectomy in papillary thyroid cancer: A comparative analysis of surgical outcomes in 240 consecutive patients. Head Neck 2023; 45:827-837. [PMID: 36606489 DOI: 10.1002/hed.27295] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/10/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study compared the surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) in papillary thyroid cancer (PTC). METHODS The TOETVA and TORT groups comprised 119 and 121 patients between November 2016 and May 2022. Clinico-surgical outcomes and operation times were retrospectively reviewed. RESULTS The TORT group showed a higher number of retrieved central compartment lymph nodes, shorter hospital stays, and lower pain score after 48 h than the TOETVA group. No significant difference was observed in the other postoperative complications, including permanent vocal cord palsy. Total operation, working space creation, and endoscopic or robotic surgery times of the TORT group were longer than those of the TOETVA group. CONCLUSIONS TORT and TOETVA are feasible and safe. TORT may have some advantages, such as central compartment node dissection, shorter hospital stays, and pain score after 48 h in PTC, despite a longer operative time.
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Affiliation(s)
- Jun Ho Lee
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.,Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hee Jun Choi
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.,Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
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Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
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Pace-Asciak P, Russell JO, Tufano RP. Review: Improving quality of life in patients with differentiated thyroid cancer. Front Oncol 2023; 13:1032581. [PMID: 36776310 PMCID: PMC9911681 DOI: 10.3389/fonc.2023.1032581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Well differentiated thyroid cancer is a common malignancy diagnosed in young patients. The prognosis tends to be excellent, so years of survivorship is expected with low risk disease. When making treatment decisions, physicians should consider long-term quality of life outcomes when guiding patients. The implications for treating indolent, slow growing tumors are immense and warrant careful consideration for the functioning years ahead. Surgery is the standard of care for most patients, however for a subset of patients, active surveillance is appropriate. For those wishing to treat their cancer in a more active way, novel remote access approaches have emerged to avoid a cervical incision. In the era of "doing less", options have further expanded to include minimally invasive approaches, such as radiofrequency ablation that avoids an incision, time off work, a general anesthetic, and the possibility of post-treatment hypothyroidism. In this narrative review, we examine the health related quality of life effects that surgery has on patients with thyroid cancer, including some of the newer innovations that have been developed to address patient concerns. We also review the impact that less aggressive treatment has on patient care and overall wellbeing in terms of active surveillance, reduced doses of radioactive iodine (RAI) treatment, or minimally invasive techniques such as radiofrequency ablation (RFA) for low risk thyroid disease.
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, ON, Canada,*Correspondence: Pia Pace-Asciak,
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Ralph P. Tufano
- Department of Otolaryngology - Head and Neck Surgery, Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, United States
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Pace-Asciak P, Russell JO, Tufano RP. Surgical treatment of thyroid cancer: Established and novel approaches. Best Pract Res Clin Endocrinol Metab 2023; 37:101664. [PMID: 35534363 DOI: 10.1016/j.beem.2022.101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Thyroid surgery is one of the most common head and neck procedures. The thyroid can be accessed through an anterior cervical incision, or by remote access techniques such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) which is favored for its ease, safety and direct plane to the thyroid gland. Other novel approaches for targeting small-localized well-differentiated thyroid cancer are by thermal ablation, namely ultrasound guided radiofrequency ablation. These innovative techniques for minimizing a cutaneous scar or for targeting small cancers directly without removal of the gland have developed alongside our realization that low risk well-differentiated thyroid cancer tends to be slow growing and indolent. Up to date, the most robust data supports offering these therapies primarily to patients who would be eligible for active surveillance protocols. In this paper, we review the traditional surgical approaches for removing well-differentiated thyroid cancer, as well as innovative remote access techniques (namely TOETVA), and minimally invasive thermal ablation (namely RFA).
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, St. Joseph's Hospital, 30 Queensway, Sunny Side West, Suite 230, M6R-1B5, Toronto, Ontario, Canada.
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Johns Hopkins Outpatient Center, 601 N. Caroline St., 6th Floor, Baltimore, MD, 21287, MD, USA.
| | - Ralph P Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, 1901 Floyd St., Ste.304, Sarasota, 34239, Florida, USA.
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Lee DW, Kim JK, Shin SH, Tae K. Transoral thyroidectomy implemented by a novice surgeon: Efforts for safe implementation. Laryngoscope Investig Otolaryngol 2022; 8:287-295. [PMID: 36846424 PMCID: PMC9948568 DOI: 10.1002/lio2.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate the feasibility, safety, and early surgical outcomes of transoral robotic and endoscopic thyroidectomy conducted by a novice surgeon. Methods We analyzed 27 patients who underwent transoral thyroidectomy between December 2018 and November 2021. All the surgeries were performed by a novice surgeon without prior endoscopic or robotic surgery experience; the surgeon had experienced 12 cases of transcervical thyroidectomy before adopting transoral thyroidectomy. Results Of the 27 cases, 1 was converted to the transcervical approach due to poor bleeding control. Four cases had transient recurrent laryngeal nerve palsy, and three had transient hypoparathyroidism. Most of the patients were very satisfied with the postoperative cosmetic outcome. Conclusions Transoral robotic and endoscopic thyroidectomies are feasible for the novice surgeon, with reasonable results in the early adoption stage if preparations are according to the suggested framework. Level of Evidence Level 4.
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Affiliation(s)
- Dong Won Lee
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Seung Heon Shin
- Department of Otorhinolaryngology‐Head and Neck Surgery, School of MedicineDaegu Catholic UniversityDaeguRepublic of Korea
| | - Kyung Tae
- Department of Otolaryngology‐Head and Neck Surgery, College of MedicineHanyang UniversitySeoulRepublic of Korea
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12
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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)—a Case Series Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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13
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Haidar Ismail N, Tavalla P, Uppal P, Adel Awad mohammed S, Rajashekar S, Giri Ravindran S, Kakarla M, Ausaja Gambo M, Yousri Salama M, Hamid P. The Advantages of Robotic Over Open Thyroidectomy in Thyroid Diseases: A Systematic Review. Cureus 2022; 14:e26320. [PMID: 35911316 PMCID: PMC9314274 DOI: 10.7759/cureus.26320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/25/2022] [Indexed: 11/09/2022] Open
Abstract
Over a hundred thousand thyroid surgeries are performed per year in the United States. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Furthermore, these techniques are new and still debatable. The purpose is to know the advantages of robotic over open thyroidectomy in thyroid diseases. Note that we didn't aim to compare different robotic techniques due to the lack of data. We performed a systematic review comparing surgical approaches for thyroidectomy, open vs robotic techniques, from January 2017 to December 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. All papers with no full free article access and not in the English language were excluded. The outcomes of interest were superior cosmetics outcome, cost-effectiveness, limitations, operation time, length of hospital stay and postoperative pain or complications, and future outcomes. A literature search was carried out in electronic databases (PubMed, Google Scholar) in order to retrieve all papers comparing the effectiveness of robotic vs open thyroidectomy. An initial reference search yielded 433 articles. Finally, we chose nine studies covering different robotic thyroidectomy techniques compared to the open thyroidectomy approach. Promising results were seen in these studies, especially with superior cosmetic results, less post-operative pain, swallowing discomfort, and voice changes. In addition, the risk of recurrent laryngeal nerve injury is almost the same as the open approach. Multiple types of biases were caused by the selection of the population and the limitation of the studies to certain regions associated with the low numbers of robotic thyroidectomy approaches in Europe and the United States of America and the lack of randomized trials and long-term follow-up respectively. All studies discussed the importance of the surgeon's skills and the patient decision in choosing the appropriate approach for the thyroidectomy depending on the risk factors, a larger number of patients, and longer follow-up from multiple hospitals.
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14
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Sun H, Wang X, Zheng G, Wu G, Zeng Q, Zheng H. Comparison Between Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and Conventional Open Thyroidectomy for Patients Undergoing Total Thyroidectomy and Central Neck Dissection: A Propensity Score-Matching Analysis. Front Oncol 2022; 12:856021. [PMID: 35311081 PMCID: PMC8925319 DOI: 10.3389/fonc.2022.856021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/04/2022] [Indexed: 01/01/2023] Open
Abstract
Background Use of the novel transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing worldwide. Although several studies have compared safety and efficacy of TOETVA and other approaches, most focused on comparisons in the context of unilateral thyroidectomy. Therefore, the present study aimed to compare the safety and surgical completeness of TOETVA with conventional open thyroidectomy (COT) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy and central neck dissection. Methods The medical records of patients who underwent TOETVA or COT by a single surgeon between June 2017 and October 2021 were retrospectively reviewed. All patients were diagnosed with PTC and underwent total thyroidectomy with central neck dissection. Propensity score-matching (PSM) was used to reduce potential selection bias and to adjust for differences in baseline clinicopathological characteristics. Results After PSM, 84 (TOETVA: 28; COT: 56) patients remained in the study population. There were no significant differences in sex, mean age, combined thyroiditis, tumor size, capsule invasion, tumor multifocality in the same lobe, or tumor location between the groups. Operative time was longer (190.54 ± 28.26 vs. 123.93 ± 29.78 min, P<0.001), while postoperative drainage volume (161.07 ± 225.30 vs. 71.16 ± 28.56 ml, P=0.045) was greater, in the TOETVA group than in the COT group. The groups exhibited no significant differences in the mean number of central lymph nodes retrieved (9.39 ± 4.01 vs. 10.71 ± 5.17, P=0.202), mean number of metastatic central lymph nodes (1.36 ± 1.93 vs. 1.77 ± 2.31, P=0.421), postoperative mean thyroglobulin levels (0.08 ± 0.24 vs. 0.10 ± 0.27, P=0.686), rate of transient hypoparathyroidism (TOETVA: 67.9% vs. COT: 66.1%, P=0.870), rate of transient vocal cord palsy (TOETVA: 0% vs. COT: 1.8%, P=1.000), or other complications (TOETVA: 3.6% vs. COT: 0%, P=0.333). Conclusions TOETVA is a safe approach in select patients with PTC and exhibits similar efficacy to COT in terms of surgical completeness.
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Affiliation(s)
- Haiqing Sun
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaojie Wang
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guibin Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guochang Wu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Qingdong Zeng
- Department of Thyroid Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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15
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Hu B, Ding H. Evolution of Endoscopic Thyroidectomy: Will a Novel Single Channel Flexible Endoscopic Approach Change the Treatment Paradigm? Int J Gen Med 2022; 15:2795-2798. [PMID: 35300143 PMCID: PMC8922313 DOI: 10.2147/ijgm.s360138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Endoscopic thyroidectomy has evolved from a hybrid approach utilizing a laparoscopic assistant and robotic-assistance to pure flexible endoscopic thyroidectomy without laparoscopic assistance. However, all the hybrid approaches are complicated and results in scar somewhere on the body surface. Current experimental and clinical studies focus on the implementation of new minimally invasive approaches such as flexible endoscopic thyroidectomy which leaves no scar on the body surface and easier to perform. Flexible endoscopic thyroidectomy is seeming to be a relatively safe and feasible technique with good outcomes. However, more research, particularly using newly developed tools to further improve this technique, and large scaled practice is needed to make it more available to patients worldwide. This article summarizes established endoscopic thyroidectomy techniques and highlight the pros and cons of different available endoscopic approaches to thyroid resection, and discussed how flexible endoscopic thyroidectomy compares to the well establish techniques and future perspective.
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Affiliation(s)
- Bowen Hu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People’s Republic of China
- Correspondence: Bowen Hu, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, People’s Republic of China, Tel +86-15286819833, Email
| | - Huanfei Ding
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People’s Republic of China
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16
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You JY, Park DW, Anuwong A, Kim HY. Reply to "Prevention of transoral thyroidectomy complications: An analysis of surgical outcomes in 423 consecutive series.". Surgery 2021; 171:1133-1134. [PMID: 34809968 DOI: 10.1016/j.surg.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ji Young You
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Da Won Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.
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17
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Kim JK, Choi SH, Choi SM, Choi HR, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method. Surg Endosc 2021; 36:2688-2696. [PMID: 34741206 PMCID: PMC8921151 DOI: 10.1007/s00464-021-08837-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022]
Abstract
Background This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method. Methods START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5 cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed. Results Among the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range: 13–58 years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7 kg/m2 (range: 15.9–37.0 kg/m2). All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23 min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29 min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method. Conclusions START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08837-9.
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Affiliation(s)
- Jin Kyong Kim
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sun Hyung Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Soon Min Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hye Ryeon Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Gyeonggi-do, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Woong Youn Chung
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Transoral robotic thyroidectomy: First case as a new technique in Vietnam. Oral Oncol 2021; 122:105542. [PMID: 34571461 DOI: 10.1016/j.oraloncology.2021.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
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19
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Honglei G, Shahbaz M, Farhaj Z, Ijaz M, Kai SY, Davrieux CF, Cheng SZ. Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center, large cohort study. Medicine (Baltimore) 2021; 100:e26943. [PMID: 34449459 PMCID: PMC8389940 DOI: 10.1097/md.0000000000026943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.The average age was 50.1 ± 11.7 (21-83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1-8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm2 ± 3.63 (0.09-23.45 cm2). The average ablation time was 11 minutes ± 5.36 (3-20 minutes). The hospitalization period was 24 hours ± 10.16 (7-48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.
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Affiliation(s)
- Gao Honglei
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Muhammad Shahbaz
- Department of Radiology, Qilu Hospital, Shandong University, China
- Research Center for Sectional and Imaging Anatomy, Digital Human Institute, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
- Department of General Surgery, Qilu Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Muhammad Ijaz
- Department of Pharmacology, Shandong University, School of Pharmaceutical Sciences, China
| | - Sun Yu Kai
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimal Invasive Surgery, Buenos Aires, Argentina
- Sanatorio de la Mujer, Rosario, Argentina
| | - Sun Zuo Cheng
- Department of General Surgery, Weifang People's Hospital, Shandong, China
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20
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Kim J, Sosa JA. Looking beyond the cosmetic appeal of transoral thyroidectomy. Br J Surg 2021; 108:875-876. [PMID: 34142113 DOI: 10.1093/bjs/znab180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- J Kim
- Department of Surgery, Inova Health System, Fairfax, Virginia, USA
| | - J A Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
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21
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Prevention of transoral thyroidectomy complications: An analysis of surgical outcomes in 423 consecutive series. Surgery 2021; 170:1155-1159. [PMID: 34090673 DOI: 10.1016/j.surg.2021.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although there are several publications on the new transoral robotic thyroidectomy technique, few have thoroughly reviewed its associated complications. This study analyzed the causes and prevention of transoral robotic thyroidectomy-specific complications and presented preventive measures. METHODS The medical records of patients who underwent transoral robotic thyroidectomy performed by a single surgeon between March 1, 2009 and April 30, 2019 were retrospectively analyzed. Patient demographic, clinical, and operative data were analyzed using descriptive statistics. We describe the transoral robotic thyroidectomy-related complications experienced at our institution and how to overcome them. RESULTS This study included a total of 423 patients who underwent transoral robotic thyroidectomy. The general surgical complications included immediate postoperative bleeding (2 cases) and delayed hematoma (3 cases). Chyle leakage and localized wound infection were found in 1 case each. Transient vocal cord palsy occurred in 4 cases, and 1 case developed transient hypoparathyroidism. The transoral robotic thyroidectomy-specific complications included zygoma bruise (2 cases), flap bruise (3 cases), chin flap perforation (2 cases), and oral commissure tearing (2 cases). The complications occurring when creating the flap included flap burns (4 cases), skin dimpling in the midline of the lower chin (2 cases), and hematomas in the intraoral trocar insertion sites (3 cases). CONCLUSION Surgeons familiar with thyroid surgery and experienced in robotic surgery can perform transoral robotic thyroidectomy without causing more complications than those seen with traditional surgery.
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22
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Surgical outcomes of different approaches in robotic assisted thyroidectomy for thyroid cancer: A systematic review and Bayesian network meta-analysis. Int J Surg 2021; 89:105941. [PMID: 33864953 DOI: 10.1016/j.ijsu.2021.105941] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of the study was to assess the feasibility, safety, and potential benefits of four approaches of robotic assisted thyroidectomy (RT). The approaches mentioned above are also compared with traditional open thyroidectomy (OPEN). MATERIALS AND METHODS Medline, Embase, Cochrane library (CENTRAL) and Web of Science databases were searched up to 13th Dec 2019. Data of surgical outcomes and complications were extracted to conduct the statistical analyses. RESULTS A total of 30 studies with 6622 patients were included. Ten were prospective study and 1 declared prospective randomized comparative study. The number of retrieved lymph nodes (LNs) in central compartment were similar between gasless transaxillary approach (GAA), bilateral axillo-breast approach (BABA) and transoral approach (OA). OPEN retrieved more LNs than BABA and OA. More metastatic LNs were seen in GAA and BABA than OA, as was for OPEN. The operation time was significantly shorter in GAA and gasless unilateral transaxillary approach (GUAA) than BABA and OA, while shortest for OPEN. Lower incidence of transient hypoparathyroidism was found in BABA than OPEN. No significant difference was observed in other indexes. CONCLUSIONS BABA, GAA, GUAA and OA in RT appear to be feasible and safe for patients with thyroid cancer with unique benefits. Surgical outcomes of different approaches were not identical for operation time, cosmetic effects, central neck dissection. Surgeons would consider more about patients' will.
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23
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Efficacy of minimally invasive video-assisted thyroidectomy for completion thyroidectomy. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Angelou A. Transoral Vestibular Thyroidectomy: Is the New Era Already Here? Indian J Surg 2020. [DOI: 10.1007/s12262-020-02217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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25
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Yang SM, Park WS, You JY, Park DW, Kangleon-Tan HL, Kim HK, Dionigi G, Kim HY, Tufano RP. Comparison of postoperative outcomes between bilateral axillo-breast approach-robotic thyroidectomy and transoral robotic thyroidectomy. Gland Surg 2020; 9:1998-2004. [PMID: 33447550 DOI: 10.21037/gs-20-468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The use of robotic systems for thyroidectomy has increased as it enables more diverse approaches than the conventional open method. The aim of this study was to compare the clinical outcomes of Transoral Robotic Thyroidectomy (TORT) and Bilateral Axillo-Breast Approach-Robotic Thyroidectomy (BABA-RT). Methods This study was designed as a retrospective study. The included patients who underwent surgery by BABA-RT or TORT approach in our facility between 2008 and 2018. All surgeries were performed by one surgeon. Total thyroidectomy with central node dissection (CND) was performed only if tumors were >4 cm and had extrathyroidal extension, clinically apparent lymph node or distant metastases. In all other cases, lobectomy ± CND was performed. Results The group treated with TORT comprised 248 patients and the group that underwent BABA-RT had 316 patients. The number of retrieved lymph node (LN) was higher in the TORT group (4.9±4.4 vs. 4.2±4.9; P=0.01). There were no significant differences between the TORT and BABA-RT groups in concerns to the location of the tumor. Postoperative hospital stay was also shorter in the TORT group when compared with the BABA-RT group (2.8±0.90 vs. 3.4±0.97 days, P=0.012). Operative time was significantly shorter in the TORT group (204.11±40.19 vs. 243.78±57.16 min, P<0.01). Conclusions When comparing a total of 248 patients treated with TORT versus 316 with BABA-RT. TORT not only has advantages in better cosmetic outcomes with minimized postoperative scars, but also shows comparable, or even superior, surgical outcomes with shorter operation time than the BABA-RT procedure.
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Affiliation(s)
- Sun Moon Yang
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Seo Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji Young You
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Da Won Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - Hong Kyu Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimal Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G.Barresi', University Hospital "G.Martino", University of Messina, Messina, Italy
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kandil E, Akkera M, Shalaby H, Munshi R, Attia A, Elnahla A, Shalaby M, Abdelgawad M, Grace L, Kang SW. A Single Surgeon's 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery. Am Surg 2020; 87:638-644. [PMID: 33142070 DOI: 10.1177/0003134820950300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America. . METHODS This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. RESULTS Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. DISCUSSION Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.
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Affiliation(s)
- Emad Kandil
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mounika Akkera
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hosam Shalaby
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ruhul Munshi
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdallah Attia
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ahmed Elnahla
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Abdelgawad
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lee Grace
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sang W Kang
- 5783 Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Richmon JD. Lateral Vestibular Approach to the Central Neck for Thyroid and Parathyroid Surgery: A Cadaveric Study. J Laparoendosc Adv Surg Tech A 2020; 31:579-583. [PMID: 33035123 DOI: 10.1089/lap.2020.0747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: The transoral endoscopic approach to the central neck has rapidly become one of the most widely utilized remote-access approaches for thyroid and parathyroid surgery in the world. The approach involves three small incisions inside the lower lip and has an optimal cosmetic outcome with no visible scar. However, the technique is quite difficult and poses several challenges that limit its widespread adoption. To overcome these issues, a novel lateral vestibular approach (LaVA) was explored in cadavers. Methods: Study using 7 fresh human cadavers that were dissected using open and endoscopic techniques to explore the feasibility of a transoral vestibular approach to the central neck without gas insufflation. Results: This novel approach resulted in wide access to the central neck and allowed for a total thyroidectomy and central neck dissection while preserving the marginal mandibular and mental nerves. Conclusions: LaVA permits excellent access to the central neck with a wide working space without the need for gas insufflation and overcomes many of the limitations of current transoral endoscopic approaches to the central neck.
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Affiliation(s)
- Jeremy D Richmon
- Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, USA
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28
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Tunca F, Dural AC, Sahbaz NA, Akarsu C, Sormaz IC, Saygi Emir N, Guzey D, Giles Senyurek Y. Pure transoral robotic thyroidectomy; institutional adaptation and early results from a tertiary endocrine surgery centre. Int J Med Robot 2020; 16:1-8. [PMID: 32835431 DOI: 10.1002/rcs.2151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Novel thyroidectomy techniques have been described to minimize the visible scar. Hereby, we aim to present our experience with transoral robotic thyroidectomy (TORT) without axillary access. MATERIAL AND METHODS Between August 2018 and March 2019, six eligible patients were enrolled to undergo TORT. Procedures were performed by using the Da Vinci Xi platform under intermittent intraoperative nerve monitoring. RESULTS All patients were female, and the mean age was 40.0 ± 14.4 years. Three patients underwent total thyroidectomy, and lobectomy was performed for the remaining three patients. In one patient, the procedure was converted to conventional open thyroidectomy due to bleeding. The mean docking time, console time and total operative time were 22.8 ± 5.2 min, 118.5 ± 48.7 min and 218.29 ± 50.6 min for total thyroidectomy and 21.8 ± 4.1 min, 68.6 ± 6.1 min and 177.6 ± 15.1 min for lobectomy, respectively. All patients were discharged uneventfully. CONCLUSIONS Pure TORT is a safe procedure, when performed in carefully selected patients by experienced surgeons, but further prospective studies with larger number of patients are required.
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Affiliation(s)
- Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cevher Akarsu
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Cem Sormaz
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nalan Saygi Emir
- Department of Anesthesiology, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Deniz Guzey
- Department of General Surgery, University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Chen LW, Razavi CR, Hong H, Fondong A, Ranganath R, Khatri S, Mydlarz WK, Mathur A, Ishii M, Nellis J, Shaear M, Tufano RP, Russell JO. Cosmetic outcomes following transoral versus transcervical thyroidectomy. Head Neck 2020; 42:3336-3344. [DOI: 10.1002/hed.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lena W. Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Christopher R. Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Akeweh Fondong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Surya Khatri
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech K. Mydlarz
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Aarti Mathur
- Division of Surgical Oncology, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Masaru Ishii
- Division of Rhinology and Sinus, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jason Nellis
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
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Kim HY, Park D, Bertelli AAT. The pros and cons of additional axillary arm for transoral robotic thyroidectomy. World J Otorhinolaryngol Head Neck Surg 2020; 6:161-164. [PMID: 33073210 PMCID: PMC7548390 DOI: 10.1016/j.wjorl.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation. Transoral robotic thyroidectomy (TORT) can be done either using just two robot arms for instruments and an extra one for the endoscopic camera, or using three robot arms for instruments (third arm through axila) and an additional arm for the camera. Pros of additional axillary arm for TORT The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue. The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation. Ultimately, these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups. Cons of additional axillary arm for TORT One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar. Another issue to consider is the cost. In some places, robotic surgery operation fee varies with the number of arms used during the operation. Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction. Conclusion TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.
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Affiliation(s)
- Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Dawon Park
- Department of Surgery, Division of Breast and Endocrine Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Antonio A T Bertelli
- Department of Surgery, Head and Neck Surgery Division, Santa Casa de Sao Paulo Medical School, Sao Paulo, SP, Brazil
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Fernandez-Ranvier G, Meknat A, Guevara D, Taye A, Suh H, Inabnet WB. Transoral Endoscopic Thyroidectomy Vestibular Approach: A Single-institution Experience of the First 50 Cases. Surg Innov 2020; 27:439-444. [PMID: 32496175 DOI: 10.1177/1553350620927611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has evolved from a novel procedure to a cosmetically appealing alternative to the traditional open thyroidectomy. TOETVA is limited to only high-volume centers with the hope to expand and demonstrate the safety, reproducibility, and application for the correct patient with thyroid disease. We present our experience with the first 50 TOETVA procedures performed at our institution. Methods. From September 2016 to June 2018, we performed 50 transoral endoscopic thyroidectomies via the vestibular approach for a variety of thyroid pathologies. Outcomes were analyzed from a prospectively maintained database. Patients were treated for a different range of thyroid pathologies. Results. A total of 12 (24%) patients underwent total thyroidectomy, whereas 38 (76%) patients underwent a subtotal thyroidectomy or thyroid lobectomy. The mean surgical time was 149 ± 40.0 (90-256) minutes for lobectomy and 217.6 ± 33.3 (175-276) minutes for total thyroidectomy. Of our 50 patients, 16 (32%) had postoperative transient lower lip numbness with an average time to recovery of 23.8 (.43-48) weeks, with 1 (2%) patient having persistent, but improving, lower lip numbness beyond the 6-month follow-up. There were 13 (26%) patients with transient chin numbness with an average time to recovery of 15.7 (2-48) weeks. Two (4%) patients had transient recurrent laryngeal nerve (RLN) injury with hoarseness, whereas 1 (2%) patient had permanent injury. Conclusion. The TOETVA is a safe and reproducible procedure. For selected patients, this technique is a viable alternative to conventional thyroidectomy.
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Affiliation(s)
| | - Aryan Meknat
- Department of Surgery, Mount Sinai Hospital, 5925Icahn School of Medicine at Mount Sinai, USA
| | - Daniela Guevara
- Department of Surgery, Mount Sinai Hospital, 5925Icahn School of Medicine at Mount Sinai, USA
| | - Aida Taye
- Department of Surgery, Mount Sinai Hospital, 5925Icahn School of Medicine at Mount Sinai, USA
| | - Hyunsuk Suh
- Department of Surgery, Mount Sinai Hospital, 5925Icahn School of Medicine at Mount Sinai, USA
| | - William B Inabnet
- Department of Surgery, 12252University of Kentucky College of Medicine, USA
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Fernandez-Ranvier G, Meknat A, Guevara DE, Inabnet WB. Transoral Endoscopic Thyroidectomy Vestibular Approach. JSLS 2020; 23:JSLS.2019.00036. [PMID: 31719772 PMCID: PMC6830499 DOI: 10.4293/jsls.2019.00036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Remote-access thyroid surgery has gained popularity and has advanced significantly over the past two decades, given the patient desire to avoid cosmetically displeasing scarring. It has only been recently that natural-orifice transluminal endoscopic surgery (NOTES) techniques have been geared for thyroidectomies. The transoral endoscopic thyroidectomy vestibular approach has been categorized as a NOTES procedure—given the approach to the thyroid gland via incisions in the oral cavity. Our aim is to provide a review of the current literature on the transoral endoscopic thyroidectomy vestibular approach (TOETVA), to present the worldwide experience of this novel procedure, and to outline whether individual patients have characteristics that would make the procedure feasible for this technique. Methods: A literature review was done to compile articles detailing the international experience with TOETVA. Our experience combined with what has been published in the literature was used to establish which pathological and patient characteristics make this particular technique feasible for a thyroidectomy. Results: We detail in the provided tables both feasibility for this surgical technique and the international experience. Conclusion: TOETVA represents the latest remote-access endoscopic technique for the excision of the thyroid gland. TOETVA is being performed at various international institutions and multiple hospitals in the United States.
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Affiliation(s)
- Gustavo Fernandez-Ranvier
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aryan Meknat
- Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Daniela E Guevara
- Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William B Inabnet
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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33
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The future of robotic surgery in otolaryngology – head and neck surgery. Oral Oncol 2020; 101:104510. [DOI: 10.1016/j.oraloncology.2019.104510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/29/2022]
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Chae S, Min SY, Park WS. Comparison Study of Robotic Thyroidectomies Through a Bilateral Axillo-Breast Approach and a Transoral Approach. J Laparoendosc Adv Surg Tech A 2020; 30:175-182. [DOI: 10.1089/lap.2019.0585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sumin Chae
- Department of Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sun Young Min
- Department of Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Won Seo Park
- Department of Surgery, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Fernandez Ranvier G, Meknat A, Guevara DE, Llorente PM, Vidal Fortuny J, Sneider M, Chen YH, Inabnet W. International Multi-institutional Experience with the Transoral Endoscopic Thyroidectomy Vestibular Approach. J Laparoendosc Adv Surg Tech A 2020; 30:278-283. [PMID: 31951503 DOI: 10.1089/lap.2019.0645] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Surgical approaches to thyroidectomies have undergone a rapid evolution over the past three decades. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the latest remote access procedure for the treatment of benign and malignant thyroid disease. The purpose of this article is to present the results of TOETVA from five different international institutions. Materials and Methods: From 2016 to 2019, 152 TOETVA procedures were performed on 149 patients at five separate international institutions. Outcomes were analyzed from a prospectively maintained database. There were 12 (8%) men and 137 (92%) women with mean ages of 41.5 ± 10.3 (27-69) and 46.9 ± 1.8 (17-78), respectively. Results: There were 3 (2%) cases that required conversion from the endoscopic approach to an open procedure. A thyroid lobectomy was performed in 111 (73.0%) cases, total thyroidectomy in 38 (25.0%) cases whereas a completion thyroidectomy in 3 (2.0%) cases. Mean operative times were 161.8 ± 42.4 (83-304) minutes for the lobectomy, 213.4 ± 71.7 (120-430) minutes for the total thyroidectomy, and 136.7 ± 109.8 (64-263) minutes for the completion thyroidectomy. The final pathology report revealed 107 (70.4%) benign nodules, 44 (28.9%) nodules with underlying papillary thyroid carcinoma, and 1 (0.7%) case with Hurthle cell carcinoma. Of the 152 cases, 7 (4.7%) patients developed temporary hypoparathyroidism. There were 5 (3.3%) patients who developed transient recurrent laryngeal nerve (RLN) injury and 3 (2.0%) with persistent injury of the RLN. Temporary lower lip numbness was noted in 51 (33.6%) patients whereas 1 (0.7%) patient was noted to have persistent numbness. We reported 57 (38.5%) patients with temporary chin numbness, 9 (5.9%) patients with skin injuries, and 2 (1.3%) with tracheal perforation. Conclusion: To date, the literature and the outcomes from these 5 international institutions have determined that, in select patients, TOETVA can be as safe and efficacious as the traditional trans-cervical technique for the treatment of specific thyroid pathologies.
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Affiliation(s)
- Gustavo Fernandez Ranvier
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aryan Meknat
- Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Daniela E Guevara
- Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jordi Vidal Fortuny
- Department of Surgery, Swiss Medical Network, Clinique de Genolier and Clinique Valére, Genolier, Switzerland
| | - Mark Sneider
- Department of Surgery, United Hospital Allina Health, St. Paul, Minnesota
| | - Yu-Hsien Chen
- Department of Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - William Inabnet
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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36
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Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc 2020; 35:124-129. [PMID: 31925503 DOI: 10.1007/s00464-020-07369-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Various approaches for thyroid surgery became possible with the use of robotic systems. Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. In this study, we compared the surgical outcomes of TORT and conventional open thyroidectomy (OT). METHODS We retrospectively reviewed and compared the medical records of consecutive patients who underwent TORT or OT for thyroid carcinoma from March 2009 to January 2018. Propensity score matching using 10 clinico-pathologic factors was used to generate two matched cohorts, each composed of 186 patients. RESULTS The study included 372 patients who underwent TORT (n = 186) or OT (n = 186). Mean age, tumor size, and gender were not different between both groups. The two groups showed similar surgical outcomes, except for a longer operative time for TORT. There was one patient with immediate postoperative bleeding in the TORT group. The patient underwent re-operation for hemostasis with endoscopic approach. In the OT group, one patient had wound seroma, which was treated by several rounds of needle aspiration without infection. Vocal cord palsy was present in one patient in the TORT group, which was recovered in 3 months. CONCLUSIONS TORT could be performed safely and had comparable surgical outcomes with OT in the selected patients. TORT may be a suitable operative alternative for patients who do not want to leave scars on the neck.
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Chan JYK, Koh YW, Richmon J, Kim J, Holsinger FC, Orloff L, Anuwong A. Transoral thyroidectomy with a next generation flexible robotic system: A feasibility study in a cadaveric model. Gland Surg 2019; 8:644-647. [PMID: 32042671 DOI: 10.21037/gs.2019.10.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Transoral endoscopic thyroidectomy provides access via the oral vestibule and gas insufflation to provide reliable remote access surgery to perform a total thyroidectomy. The da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a next generation flexible single port system that offers unique advantages over previous robotic rigid systems. Here we sought to evaluate the feasibility of performing transoral thyroidectomy with this next generation flexible robotic system. Methods Cadaveric dissection with gas insufflation to test the feasibility of performing transoral thyroidectomy with the da Vinci SP. Results A 2 cm incision was made in the oral vestibule and the working space created with a 1cm central port and two lateral 5 mm ports. Then an extra small wound protector (Applied Medical, Rancho Santa Margarita, CA) was placed through the central incision after closure of the 5 mm ports. The robotic system was then deployed through the wound protector while insufflation was maintained at ~6 mmHg. Three instrument arms were deployed. A fenestrated bipolar was used to grasp the thyroid gland while Maryland bipolars and monopolar scissors were used to mobilize each hemi lobe of the thyroid. The recurrent laryngeal nerves were seen and preserved bilaterally. After completion of the surgery and removal of the wound protector the vestibular incision was measured to be 3 cm. Further dissection to identify the mental nerves identified each nerve to be >1 cm from the lateral extent of the central incision. Conclusions In summary, it is feasible to perform a total thyroidectomy with gas insufflation utilizing this next generation flexible robotic system. Further evaluation will be needed to validate the clinical applicability of this technique.
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Affiliation(s)
- Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Yoon W Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jaewook Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University Hospital, College of Medicine, Seoul, South Korea
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Lisa Orloff
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand
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Liao D, Ishii LE, Chen LW, Chen J, Juarez M, Darrach HM, Kumar AR, Russell JO, Tufano RP, Ishii M. Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery. Laryngoscope 2019; 130:1603-1608. [PMID: 31660610 DOI: 10.1002/lary.28305] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. METHODS Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. RESULTS One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P < .0001). Observers attended significantly more to the neck (0.20 seconds, P < .0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (-0.24 seconds, P = .0031; 95% CI, -0.39, -0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P = .0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P = .1345). Observer race and gender did not significantly affect attention to neck scars. CONCLUSION Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. LEVEL OF EVIDENCE NA Laryngoscope, 130:1603-1608, 2020.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lena W Chen
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonlin Chen
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Michelle Juarez
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Anisha R Kumar
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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You JY, Kim HY, Dionigi G, Tufano RP. Transoral Robotic Thyroidectomy: the New Era of Remote-Access Surgery for Thyroid Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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Park D, Shaear M, Chen YH, Russell JO, Kim HY, Tufano RP. Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO 2 insufflation: Preclinical feasibility study. Head Neck 2019; 41:4229-4233. [PMID: 31469475 DOI: 10.1002/hed.25939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/15/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transoral vestibular approach endoscopic thyroidectomy has gained popularity worldwide because it avoids a cutaneous incision. Some surgeons have expressed reservations about operating with only 2 instruments in the endoscopic technique, and some therefore utilize an axillary incision as an adjunct to facilitate dissection. The Intuitive da Vinci single port robotic system offers the potential to overcome this limitation without an axillary incision. METHODS In this study, the Intuitive da Vinci single port robotic surgical system was used to perform transoral thyroidectomy on 2 human cadavers. RESULTS A total thyroidectomy was performed in 2 cadavers using the da Vinci single port (SP) robot via transoral vestibular technique. The dissections were performed with removal of the thyroid gland and preservation of the recurrent laryngeal nerves and parathyroid glands. CONCLUSION In our evaluation, transoral vestibular approach robotic thyroidectomy using the Intuitive da Vinci SP system facilitated dissection without the need for an axillary incision.
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Affiliation(s)
- Dawon Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mohammad Shaear
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jonathon O Russell
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ralph P Tufano
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Extracervical Approaches to Thyroid Surgery: Evolution and Review. Minim Invasive Surg 2019; 2019:5961690. [PMID: 31531238 PMCID: PMC6719267 DOI: 10.1155/2019/5961690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/10/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Over the last two decades, advances and adaptation of technology have led to a variety of endoscopic thyroidectomy procedures being performed. The drive for extracervical procedures has been predominantly influenced by the desire for improved cosmesis via avoidance of visible scars. Extracervical techniques have shown considerable evolution with approaches that have included transaxillary, breast, postauricular, and transoral routes. There has been a varied evidence base for each of these approaches with regard to technical feasibility, safety, patient satisfaction, and cost-effectiveness. In recent years, robotic-assisted thyroid surgery has gained increased popularity worldwide with the introduction of the da Vinci Robot. Reports of improved postoperative outcomes and patient satisfaction have been in contrast to the financial burden, longer operative time, and increased training required which, to date, have limited widespread application. The aim of this review is to describe the evolution of extracervical procedures including surgical approaches, outcomes, advantages, and disadvantages. Consideration is also given to the future direction of extracervical thyroid surgery with regard to the safety, feasibility, and application of robotic systems.
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Tai DKC, Kim HY, Park D, You J, Kim HK, Russell JO, Tufano RP. Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients. Laryngoscope 2019; 130:1343-1348. [PMID: 31408213 DOI: 10.1002/lary.28239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Obesity is an increasing health concern worldwide. It has been associated with perioperative complications that could affect patient outcomes. Our aim was to compare surgical outcomes in obese and nonobese patients after transoral robotic thyroid (TORT) surgery. STUDY DESIGN Retrospective cohort study. METHODS A total of 304 consecutive patients who underwent TORT between January 2012 to December 2017 were included in the study. Patients were divided into two groups according to their body mass index (BMI): BMI < 30 kg/m2 and BMI ≥30 kg/m2 . Patient demographics, operative extent, pathological data, surgical outcomes, and postoperative complications were included and analyzed. A χ2 test was used to compare categorical variables, and a Student t test was used to compare changes of continuous variables between groups. Statistical significance was conferred by a two-tailed P value of ≤.05. RESULTS There were 290 patients in the non-obese group and 14 patients in the obese group. There was no statistically significant difference between the two groups in terms of patient demographics, operative procedure, or pathological characteristics. The only statistically significant difference was for lymph node dissection (P = .012); however, for both groups, unilateral central node dissection was the most common procedure. There was also no statistically significant difference found for operative time, length of stay, pain score, or postoperative complications including TORT-specific complications such as oral commissure tear and general complications such as recurrent nerve injury. CONCLUSIONS This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery. LEVEL OF EVIDENCE NA Laryngoscope, 130:1343-1348, 2020.
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Affiliation(s)
- Dora Kai Chun Tai
- Department of Surgery, Queen Elizabeth Hospital, Jordan, Kowloon, Hong Kong
| | - Hoon Yub Kim
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Dawon Park
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Jiyoung You
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Hong Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Liu P, Zhang Y, Qi X, Liu H, Du J, Liu J, Liu J, Fu W, Zhang Y, Jiang J, Fan L. Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon. J Cancer 2019; 10:3851-3859. [PMID: 31333802 PMCID: PMC6636286 DOI: 10.7150/jca.31463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/04/2019] [Indexed: 12/14/2022] Open
Abstract
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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Affiliation(s)
- Pengfei Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.,Department of Breast Surgery, First Affiliated Hospital, Hunan Traditional Chinese Medical College, Hunan Provence, China
| | - Ye Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaowei Qi
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Haoxi Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junze Du
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jing Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junlan Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenying Fu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jun Jiang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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You JY, Kim HY, Chai YJ, Kim HK, Anuwong A, Tufano RP, Dionigi G. Transoral Robotic Thyroidectomy Versus Conventional Open Thyroidectomy: Comparative Analysis of Surgical Outcomes in Thyroid Malignancies. J Laparoendosc Adv Surg Tech A 2019; 29:796-800. [DOI: 10.1089/lap.2018.0587] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Ji Young You
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hong Kyu Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimal Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G.Barresi,” University Hospital “G.Martino,” University of Messina, Messina, Italy
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Razavi CR, Tufano RP, Russell JO. Starting a Transoral Thyroid and Parathyroid Surgery Program. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019; 7:204-208. [PMID: 31396436 DOI: 10.1007/s40136-019-00246-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose of Review To describe the necessary steps to facilitate safe implementation of a transoral thyroid and parathyroid surgery program. Recent Findings Transoral vestibular approaches to the central neck have been demonstrated to be safe and feasible, while avoiding the morbidity of a cutaneous scar. As operative volume expands from a select few high-volume centers, a framework for implementation has been recommended to allow the evidence-based outcomes to translate into clinical practice for new adopters of these techniques. These include securing institutional support, choosing the appropriate candidate (both patient and surgeon), appropriate case observation and instruction (live and cadaver), and adequate first-case preparation and knowledge of the learning curve(s) for the techniques. Summary The recommendations in this article provide a foundation from which a transoral thyroid and parathyroid program may be successfully built. An intricate understanding of conventional transcervical central neck surgery and institutional support are absolute prerequisites to safe and successful implementation of these transoral vestibular techniques.
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Affiliation(s)
- Christopher R Razavi
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
| | - Ralph P Tufano
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
| | - Jonathon O Russell
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor, Baltimore, MD 21287, USA
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Park JO, Kim MR, Park YJ, Kim MS, Sun DI. Transoral endoscopic thyroid surgery using robotic scope holder: Our initial experiences. J Minim Access Surg 2019; 16:235-238. [PMID: 31031326 PMCID: PMC7440021 DOI: 10.4103/jmas.jmas_12_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background : Transoral thyroid surgery represented by the da Vinci system is attracted attention and performed by several institutions. However, the current available da Vinci system still has some limitations to be improved for transoral thyroid surgery including high cost of equipment and expendables, larger diameter scope and instruments and no tactile sensation. It triggered us interest in more easily available robotic scope holder. Soloassist II (AktorMed GmbH, Barbing, Germany) is an active endoscope holder system which is controlled by a joystick. It has total six joints: three joints which are controlled by computer, one is controlled by manual and two act as a gimbal joint following the movement of the main body. Materials and Methods We tried transoral endoscopic thyroidectomy using Soloassist II (AktorMed GmbH, Barbing, Germany) in December 2017 in our hospital. Results We successfully performed four thyroid lobectomies in four patients with Soloassist II. We refined and described surgical procedures in each step using video clips. It provided an excellent vibration-free stable surgical view which enabled fatigue-free work, without shaking or tilting the horizon. The surgeon could perform transoral endoscopic thyroid surgery with only one assistant surgeon. Docking and preparation time for Soloassist was within 10 min in all four patients. The setup and dismantling could be performed parallel to the usual workflow. No complication was reported by any patient. Conclusions : The robotic scope holder (Soloassist II) seems to be safe and feasible equipment for performing transoral endoscopic thyroid surgery. Several possible advantages could be expected with this robotic scope holder.
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Affiliation(s)
- Jun-Ook Park
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Mi Ra Kim
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Haeundae Paik Hospital, Inje University of Korea, Busan, South Korea
| | - Yeong Jun Park
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Haeundae Paik Hospital, Inje University of Korea, Busan, South Korea
| | - Min-Sik Kim
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Il Sun
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Transoral Robotic Thyroidectomy: The Overview and Suggestions for Future Research in New Minimally Invasive Thyroid Surgery. ACTA ACUST UNITED AC 2019; 22:5-10. [PMID: 35601700 PMCID: PMC8979844 DOI: 10.7602/jmis.2019.22.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/25/2023]
Abstract
Purpose of review This journal introduces a overview in depth about the evolution of transoral robotic thyroidectomy, which has been encountering major confrontations in expanding its indications. Recent findings Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. The major advantage of TORT is comparatively smaller flap dissection area than other remote-access methods. The other advantage of TORT is that the wounds of lips fades out over time, and leaves concealed scar near axilla. Summary TORT can be done safely to the appropriately selected patients by surgeon expertise in robotic thyroidectomy. It might be a potential alternative surgical approach for thyroidectomy to surgeons who are experienced in remote-access robotic surgery.
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Ruhle BC, Ferguson Bryan A, Grogan RH. Robot-Assisted Endocrine Surgery: Indications and Drawbacks. J Laparoendosc Adv Surg Tech A 2019; 29:129-135. [DOI: 10.1089/lap.2018.0308] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian C. Ruhle
- Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Ava Ferguson Bryan
- Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Raymon H. Grogan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Haubner F, Canis M. [Recent progress in otorhinolaryngology]. MMW Fortschr Med 2018; 160:106-111. [PMID: 30421183 DOI: 10.1007/s15006-018-1136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Frank Haubner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - Martin Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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Tesseroli MAS, Spagnol M, Sanabria Á. Tireoidectomia endoscópica transoral por acesso vestibular (TOETVA): experiência inicial no Brasil. Rev Col Bras Cir 2018; 45:e1951. [DOI: 10.1590/0100-6991e-20181951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
RESUMO Objetivo: apresentar a experiência inicial no Brasil com a tireoidectomia transoral endoscópica por abordagem vestibular (TOETVA). Métodos: estudo prospectivo de pacientes submetidos à TOETVA no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Regional do Oeste, Chapecó, Santa Catarina. Foram candidatos para o estudo os pacientes entre 18 e 65 anos de idade, ASA I e II, com volume glandular de até 35cm3e nódulos de até de 4cm. Dados dos pacientes, dos nódulos, tempo cirúrgico, complicações, e tempo de internação foram registrados. Resultados: nove pacientes foram operados entre maio de 2017 e abril de 2018. Todos eram mulheres, com idades entre 33 e 64 anos. O tamanho do nódulo variou de 1cm a 4cm. Dois pacientes eram portadores de neoplasia maligna e a tireoidectomia total foi feita em oito casos. Sete pacientes tiveram uma internação de apenas um dia. Um paciente sofreu uma complicação menor na pele, mas não ocorreram lesões dos nervos laríngeos recorrentes ou hipoparatireoidismo definitivo. Conclusão: a TOETVA é uma técnica segura para pacientes bem selecionados, com condições favoráveis e com especial preocupação com resultados estéticos.
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Affiliation(s)
| | - Mauricio Spagnol
- Universidade Comunitária da Região de Chapecó (UNOCHAPECÓ), Brasil
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