Patient Factors Affecting Operative Times for Single-incision Trans-Axillary Robotic-assisted (STAR) Thyroid Lobectomy: Does Size Matter?

Abstract

Single-incision, transaxillary, robotic-assisted (STAR) thyroid lobectomy using a robotic surgical system is a novel surgical approach that is extensively described in Korean patients. Some have suggested that this experience will not translate into the American population because of differing body habitus and because the mean size of the thyroid nodules removed in Korea are <1 cm. We reviewed our experience with STAR thyroid lobectomy. We retrospectively reviewed our prospectively collected data on consecutive cases of STAR thyroid lobectomy performed by a single surgeon. Operative times and patient outcomes were evaluated. Seventeen operations were performed on 15 patients. Mean total operative time was 219.3 (range, 183-256) minutes. All patients were discharged on postoperative day 1. Postoperative complications were seromas (n = 2) and cellulitis (n = 2). Operative time did not vary with the size or volume of the nodule or gland. The mean nodule diameter was 1.9 (range, 0.5-3.1) cm. The mean nodule volume and thyroid volume were 5.0 (range, 0.1-16.7) cm(3) and 20.7 (range, 11.8-45.8) cm(3), respectively. When stratified by body mass index (range, 19.6-37.8), normal versus overweight or obese, total operative time increased from 204 to 225 min, and console time from 114 to 125 min. STAR thyroid surgery is a feasible technique. Factors, such as mass size, specimen volume, and patient body mass index, had little effect on operative times. These differences should not hinder the adoption of this procedure in North America, because new retractor systems help to overcome them. Further evaluation of this procedure is reasonable and safe.