Abstract
Background
Various robotic surgical procedures have been performed in recent years, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. This study aimed to introduce the authors’ technique of robot-assisted endoscopic thyroid surgery and to demonstrate its applicability in the surgical management of thyroid cancer.
Methods
From 4 October 2007 through 14 March 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci S surgical robot system. Four robotic arms were used with this system: a 12-mm telescope and three 8-mm instruments. The three-dimensional magnified visualization obtained by the dual-channel endoscope and the tremor-free instruments controlled by the robotic systems allowed surgeons to perform sharp and precise endoscopic dissections.
Results
Ipsilateral central compartment node dissection was used for 84 less-than-total and 16 total thyroidectomies. The mean operation time was 136.5 min (range, 79–267 min). The actual time for thyroidectomy with lymphadenectomy (console time) was 60 min (range, 25–157 min). The average number of lymph nodes resected was 5.3 (range, 1–28). No serious complications occurred. Most of the patients could return home within 3 days after surgery.
Conclusions
The technique of robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
Similar content being viewed by others
References
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875
Hüscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877
Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231
Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg 41:791–792
Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340
Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E (2000) Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbecks Arch Surg 385:261–264
Gagner M, Inabnet WB III (2001) Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 11:161–163
Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703
Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4
Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132:1070–1074
Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91
Lombardi CP, Raffaelli M, De Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R (2007) Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 142:944–951
Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg 31:2302–2308
Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193:114–118
Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Büchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397
Lobe TE, Wright SK, Irish MS (2005) Novel uses of surgical robotics in head and neck surgery. J Laparoendosc Adv Surg Tech A 15:647–652
Miyano G, Lobe TE, Wright SK (2008) Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg 43:299–303
Savitt MA, Gao G, Furnary AP, Swanson J, Gately HL, Handy JR (2005) Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg 79:450–455
Link RE, Bhayani SB, Kavoussi LR (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243:486–491
Bodner J, Fish J, Lottersberger AC, Wetscher G, Schmid T (2005) Robotic resection of an ectopic goiter in the mediastinum. Surg Laparosc Endosc Percutan Tech 15:249–251
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, The American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142
Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging handbook: TNM classification of malignant tumors, 6th edn. Springer-Verlag, New York
Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc 13:196–201
Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606
Ballantyne GH (2007) Telerobotic gastrointestinal surgery: phase 2 safety and efficacy. Surg Endosc 21:1054–1062
Hartmann J, Jacobi CA, Menenakos C, Ismail M, Braumann C (2008) Surgical treatment of gastroesophageal reflux disease and upside-down stomach using the Da Vinci robotic system: a prospective study. J Gastrointest Surg 12:504–509
Jacobsen G, Elli F, Horgan S (2004) Robotic surgery update. Surg Endosc 18:1186–1191
Jacob BP, Gagner M (2003) Robotics and general surgery. Surg Clin North Am 83:1405–1419
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kang, SW., Jeong, J.J., Yun, JS. et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23, 2399–2406 (2009). https://doi.org/10.1007/s00464-009-0366-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0366-x