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Robotic thyroidectomy for benign thyroid diseases: a stepwise strategy to the adoption of robotic thyroidectomy (gasless, transaxillary approach)

 George Giannopoulos  ;  Sang-Wook Kang  ;  Jong J. Jeong  ;  Kee-Hyun Nam  ;  Woong Y. Chung 
 Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, Vol.23(3) : 312-315, 2013 
Journal Title
 Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 
Issue Date
Adolescent ; Adult ; Axilla/surgery* ; Female ; Follow-Up Studies ; Guideline Adherence* ; Humans ; Incidence ; Length of Stay/trends ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Practice Guidelines as Topic* ; Republic of Korea/epidemiology ; Retrospective Studies ; Robotics/methods ; Robotics/standards* ; Thyroid Diseases/surgery* ; Thyroidectomy/methods* ; Treatment Outcome ; Young Adult
benign thyroid disease ; robotic thyroidectomy ; stepwise strategy
PURPOSE: Thyroid surgery for benign diseases mainly involves young women, and thus, cosmetic considerations have motivated the development of "no scar to the neck" procedures. Endoscopic techniques are often strenuous, and therefore, discouraging to adopt. However, the recent incorporation of robotic technology proposes a feasible, safe, extracervical approach that alleviates most of the technical difficulties associated with endoscopy. Here, the authors present a series of robotic thyroidectomies performed to treat benign thyroid diseases and detail the key issues of initial patient selection. PATIENTS AND METHODS: From November 2007 to December 2010, 44 patients with benign thyroid disease were operated upon using a robotic procedure. Indications were follicular/Hürthle cell lesions smaller than 5 cm, nodules with an indefinite/suspicious cytology, or Graves disease. All patients underwent robotic gasless, transaxillary thyroidectomy using the da Vinci S system. RESULTS: Thirty-nine of the 44 patients were women, and the overall mean age was 38.2 years (range, 16 to 60 y). The most common pathology was adenomatous hyperplasia (20 lesions) followed by follicular adenoma (10 lesions). Seven patients had Graves disease. The mean tumor size was 1.68 cm (range, 0.3 to 5 cm). Thirty-nine patients underwent less than total thyroidectomy and 5 underwent total or near total thyroidectomy. The mean total operative time was 129.8 minutes (range, 75 to 242 min) and the mean duration of postoperative hospital stay was 3.1 days (range, 2 to 5 d). Postoperative complications were 1 transient hoarseness, 1 transient hypocalcemia, and 1 permanent recurrent laryngeal nerve injury. CONCLUSIONS: Robotic thyroidectomy, although novel and sophisticated, has already been used to treat over 4000 thyroid cancer patients in Korea. Female patients with a small to average build, with a follicular lesion and concerned about neck scarring, seem to be the best candidates. Patients with small suspicious nodules without severe thyroiditis are also a rational choice. In contrast, patients with Graves disease should be reserved, unless significant experience has been gained.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Sang Wook(강상욱) ORCID logo https://orcid.org/0000-0001-5355-833X
Nam, Kee Hyun(남기현) ORCID logo https://orcid.org/0000-0002-6852-1190
Chung, Woung Youn(정웅윤)
Jeong, Jong Ju(정종주) ORCID logo https://orcid.org/0000-0002-4155-6035
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