Robot-assisted Transaxillary Thyroidectomy Research Articles

Cosmetic Result and Overall Satisfaction after Minimally Invasive Video‐assisted Thyroidectomy (MIVAT) versus Robot‐assisted Transaxillary Thyroidectomy (RATT): A Prospective Randomized Study

No studies have compared robot-assisted transaxillary thyroidectomy (RATT) and minimally invasive video-assisted thyroidectomy (MIVAT) regarding cosmetic outcome and satisfaction Patients matching the inclusion criteria (benign nodule less than 4 cm and thyroid volume less than 30 mL) were randomly allotted to undergo MIVAT (group A) or RATT (group B). Cosmetic result, overall satisfaction, operative time, and complications were evaluated. A total of 62 patients underwent hemithyroidectomy (30 in group A and 32 in group B). All patients were women, with the exception of one man in each group. The mean patient age was 36.9 years (group A) and 32.5 years (group B). Total operative time (intubation-extubation) was shorter in group A (71.6 min) than in group B (120.4 min). Complications included one transient laryngeal nerve injury in each group and one subcutaneous hematoma in group B. Postoperative hospital stay was longer in group B (1.85 days) than in group A (1.15 days). On the PASQ questionnaire, "scar appearance" and "satisfaction with appearance" scores were better in group A than in group B. In the Short Form (SF-36) 36-Item Health Survey Questionnaire, domains of "social activity" and "general health" were better in group B than in group A, whereas "bodily pain" scored higher in group B than in group A. RATT seems not to supersede MIVAT in terms of satisfaction when comparing two groups of patients undergoing thyroidectomy for benign disease.

Axillary web syndrome after transaxillary robotic thyroidectomy.

Axillary web syndrome is a self-limiting and frequently overlooked complication in the early postoperative period of axillary surgery. This entity has been described in breast cancer patients after axillary lymph node dissection. Robot-assisted transaxillary thyroidectomy is now becoming increasingly popular in part owing to the desire to avoid an obvious cervical scar. This procedure is a kind of axillary surgery, but there has been no report about axillary web syndrome after robotic transaxillary thyroidectomy. Here, we report on a 47-year-old female with axillary web syndrome after robotic transaxillary thyroid lobectomy.

Trans‐axillary Robotic Thyroidectomy and Parathyroidectomy: A Preliminary Single Institution Experience

Objectives: 1) Review our first 13 robotic assisted trans-axillary thyroidectomy and parathyroidectomy (TART/TARP) cases, looking at the clinical and pathological data as well as technical challenges associated with this approach. 2) Examine and discuss complications associated with this approach. Methods: Retrospective series of 13 patients who underwent TART/TARP at our institution. Patient demographics, pathology and size of thyroid glands removed, intraoperative details, length of stay, and postoperative complications were recorded. Results: Over a 14-month period from October 2011 to December 2012, 11 patients (12 female, 1 male) underwent TART, and 2 patients underwent TARP. Mean age was 54 years (range, 29-76 years). All thyroidectomies were partial. Both left-sided parathyroid adenomas had been localized with preoperative imaging to fit criteria for single gland exploration. The largest thyroid lobe removed was 6.5 x 3.5 x 2.8 cm. Pathology was benign thyroid disease in 9 and well differentiated papillary thyroid cancer in 2. Complications included a brachial plexus neuropraxia (n = 1), recurrent laryngeal nerve paresis (n = 1), and inadvertent parathyroid gland removal (n = 1). Both nerve injuries resolved completely in follow up. All patients were discharged within 2 days of surgery, most within 23 hours. Long-term follow up suggest good patient outcomes and patient satisfaction. Conclusions: Robot-assisted trans-axillary thyroidectomy and parathyroidectomy are feasible procedures with good outcomes. Patient selection is key to successful outcome. Surgeons should recognize distant-access related risks including brachial plexus injury and chest paresthesias in addition to conventional thyroidectomy risks and understand how best to diagnose, prevent, and manage these complications.

Trans‐axillary Robotic Thyroidectomy: Avoiding the Chest Port

Objectives: Describe modification of port placement for the four-arm technique for robotic thyroidectomy to avoid a chest incision and eliminate crowding of the working space provided by the trans-axillary incision. Methods: Description of port placement modification to avoid chest incision as well as report of two cases and appropriate literature review. Results: Placement of four arms via a trans-axillary incision requires expertise. Transitioning from a chest port for placement of the fourth arm to a single-incision surgery, avoiding a visible chest incision, can be challenging. We describe this technique and two cases of trans-axillary robotic hemithyroidectomy (TART) using a trans-axillary incision and a separate 1 cm incision in the anterior axilla, 2.5 centimeters below the trans-axillary incision, for placement of the fourth arm. This design allowed for a more ergonomic placement of the fourth arm while not compromising the working space provided by the trans-axillary incision. Additionally this port is used for surgical drain placement. Conclusions: Robot-assisted trans-axillary thyroidectomy poses several challenges in the early surgical learning curve. One roadblock to exposure and efficiency is appropriate port and arm placement. Our modification offers an alternative where a four-arm technique is made possible without a chest port and without occupying the restricted working space provided by the trans-axillary incision. Use of this inferior axillary port is cosmetically acceptable, surgically efficient, and allows avoidance of a visible chest incision for placement of the fourth arm.

Robot-Assisted Thyroidectomy with Novel Camera-Port Retractor

We performed gasless transaxillary robot-assisted thyroidectomy with a novel camera-port retractor (CP retractor). Herein, we describe the new instrument and its efficacy, which was evaluated by performing robot-assisted thyroidectomy. From October 2009 to August 2012, a total of 12 patients underwent robot-assisted thyroidectomy using the da Vinci Surgical System. The CP retractor was used in all cases, and we use the Maryland bipolar forceps and the microbipolar forceps on both arms for dissection of the surrounding tissues as well as for cutting and coagulation to avoid injury to the vessels and the nerves. The CP retractor provided excellent visualization without robotic arm instrument interference. The novel retractor is useful and safe, and the use of bipolar instruments is an effective option for robotic dissection around the nerves in the robot-assisted thyroidectomy.

Operative outcomes of robot-assisted transaxillary thyroid surgery for benign thyroid disease: early experience in 50 patients

The main benefits of robot-assisted transaxillary thyroid surgery are to overcome the technical limitations of other endoscopic procedures for this surgical pathology and to avoid any cervical skin incision. This article describes the first experience of a Romanian team with the endoscopic robot-assisted thyroid surgery. We used the da Vinci SI intuitive surgical system to carry out 50 thyroid operations: 33 unilateral total lobectomies with isthmectomy (TL), 8 unilateral total lobectomies, with contralateral subtotal lobectomy, and 9 total thyroidectomies. Preoperatively, the patients were diagnosed with nodular goiter in 42 cases, nodular autoimmune thyroiditis in 3 cases, Basedow disease in 2 cases, toxic thyroid adenoma in 2 cases, and diffuse goiter in 1 case. We analyzed the clinical characteristics, size and location of the nodules, surgery duration, postoperative complications, pain medication, histopathological findings and postoperative cosmetic results. All surgical procedures were carried out without major incidents. One case required conversion to open approach. The mean length of surgery was 159 ± 38.2min and the average console time was 68 ± 39.9min; postoperatively, we recorded one case of transient brachial plexus neurapraxia, one transient vocal cord paresis, one transient hypocalcemia, and four postoperative wound complications. The final histopathological examination revealed two cases of well-differentiated carcinoma. This paper reports the largest series to date in Southeast Europe about robot-assisted transaxillary thyroidectomy. On a group of selected Caucasian patients, postoperative results were similar to open cervicotomy in terms of postoperative complications. The major cosmetic advantage is the absence of scar in the anterior cervical region.

Patient Attitudes toward Transaxillary Robot‐assisted Thyroidectomy

The transaxillary robot-assisted technique constitutes an acceptable treatment option for patients requiring thyroidectomy. However, patients' attitudes toward this new technique have not yet been analyzed. A sample of 596 randomly selected patients who underwent thyroidectomy between January 2000 and March 2010 was assessed. We evaluated patients' attitudes toward transaxillary robot-assisted thyroidectomy, taking into account the validated Patient Scar Assessment Questionnaire, the SF-36 Health Survey Questionnaire, and 11 sociodemographic and surgical patient characteristics. Only 11.6 % of the patients would prefer to have been treated with the transaxillary method. Most patients had concerns that it would be a more painful procedure (39.2 %), and they expressed satisfaction with the existing esthetic outcome (29.1 %); other concerns were that the robotic approach would be of longer duration (25.4 %) and at higher cost (15.5 %). Nevertheless, the worse the appearance of the neck scar the more preferable is the new method (p = 0.025), a result that holds true irrespective of patients' physical health, the invasive procedure attained (conventional or minimal), and the presence of postoperative complications, among other characteristics. Patients diagnosed with a benign or uncertain neoplasm (p = 0.022) and younger patients (p = 0.003) held a more positive view of the new method. Patients who have undergone conventional thyroidectomy via the usual neck incision do not express a preference for the transaxillary method. The reasons given include various perceived disadvantages of the robotic procedure (increased pain, longer operative times, and higher cost). Younger patients, patients with poor appearance of their neck scar, and patients with benign thyroid pathology seem to hold a more positive attitude toward the robotic approach.

Robotic Thyroidectomy: Must We Drive a Luxury Sedan to Arrive at Our Destination Safely?

Robotic Thyroidectomy: Must We Drive a Luxury Sedan to Arrive at Our Destination Safely?

Subcutaneous Implantation of Adenomatous Goiter: An Unpredicted Complication of Endoscopic Thyroid Surgery

ThyroidVol. 20, No. 4 Letters to the EditorSubcutaneous Implantation of Adenomatous Goiter: An Unpredicted Complication of Endoscopic Thyroid SurgeryKyung Won Koh, Tae Hyun Lee, Soo Youn Cho, Seung-Sook Lee, Jung Min Kim, Ka Hee Yi, and Yun Yong LeeKyung Won KohDepartment of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, Tae Hyun LeeDepartment of Diagnostic Radiology, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, Soo Youn ChoDepartment of Pathology, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, Seung-Sook LeeDepartment of Pathology, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, Jung Min KimDepartment of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, Ka Hee YiDepartment of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this author, and Yun Yong LeeDepartment of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.Search for more papers by this authorPublished Online:7 Apr 2010https://doi.org/10.1089/thy.2009.0314AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited ByCase Report: Implantation of Dedifferentiated to Poorly Differentiated Thyroid Carcinoma After Endoscopic Thyroid Surgery6 May 2022 | Frontiers in Oncology, Vol. 12Subcutaneous implantation of oncocytic thyroid cell aggregates nine years later from thyroidectomy. A case reportInternational Journal of Surgery Case Reports, Vol. 93Postsurgical complications after robot-assisted transaxillary thyroidectomy: critical analysis of a large cohort of European patients3 March 2022 | Updates in Surgery, Vol. 74, No. 2First report of benign track seeding after robot-assisted transaxillary thyroid surgeryAmerican Journal of Otolaryngology, Vol. 42, No. 1Récidive multifocale sur la voie d’abord trans-axillaire d’une thyroïdectomie sous assistance robotiqueAnnales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Vol. 137, No. 1Multifocal recurrence on the transaxillary robotic thyroidectomy incisionEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, Vol. 137, No. 1Cervical soft tissue recurrence of differentiated thyroid carcinoma after thyroidectomy indicates a poor prognosisInternational Journal of Surgery, Vol. 48Track Recurrence After Robotic Transaxillary Thyroidectomy: A Case Report Highlighting the Importance of Controlled Surgical Indications and Addressing Unprecedented Complications1 April 2016 | Thyroid, Vol. 26, No. 4Ectopic Subcutaneous Implantation of Thyroid Tissue After Gasless Transaxillary Robotic Thyroidectomy for Papillary Thyroid Cancer17 December 2015 | Thyroid, Vol. 25, No. 12Extrathyroidal Implantation of Thyroid Hyperplastic/neoplastic Cells after Endoscopic Thyroid SurgeryChinese Medical Sciences Journal, Vol. 29, No. 3Squamous Cell Carcinoma of the Pectoralis Major Myocutaneous Flap Donor SiteJournal of Oral and Maxillofacial Surgery, Vol. 72, No. 7Implantation at Sternocleidomastoid and Chest Wall After Endoscopic Thyroid Carcinoma SurgerySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, Vol. 22, No. 4Minimally Invasive Techniques in Thyroid Surgery15 June 2012 Volume 20Issue 4Apr 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Kyung Won Koh, Tae Hyun Lee, Soo Youn Cho, Seung-Sook Lee, Jung Min Kim, Ka Hee Yi, and Yun Yong Lee.Subcutaneous Implantation of Adenomatous Goiter: An Unpredicted Complication of Endoscopic Thyroid Surgery.Thyroid.Apr 2010.441-443.http://doi.org/10.1089/thy.2009.0314Published in Volume: 20 Issue 4: April 7, 2010Online Ahead of Print:March 8, 2010PDF download