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Surgical Safety and Oncologic Effectiveness in Robotic versus Conventional Open Thyroidectomy in Thyroid Cancer: A Systematic Review and Meta-Analysis

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although many experiences using the da Vinci Robot System have been reported by several groups, there is substantial controversy over the role of the robot in thyroidectomy. We performed a systematic review and meta-analyses in order to evaluate the safety and effectiveness of robotic thyroidectomy (RT) compared with open thyroidectomy (OT) in thyroid cancer.

Methods

A literature search for the systematic review was conducted using English databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library), as well as domestic databases, up to June 2014.Outcomes of interest included demographic characteristics, adverse events and complications, and outcomes of effectiveness.

Results

Fourteen publications including 3,136 cases were finally selected for the systematic review and meta-analysis. RT was associated with an equivalent complication rate including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, seroma, length of hospital stay, and postoperative thyroglobulin level when compared with OT. RT also had lesser blood loss (weighted mean difference [WMD]−0.28, p = 0.04), better cosmetic satisfaction (odds ratio 4.79, p < 0.001), and lower level of swallowing impairment (WMD −4.17, p < 0.001) than OT. OT was in favor of operation time (WMD 39.77, p < 0.001) and retrieved lymph nodes (WMD −0.62, p = 0.02) compared with RT.

Conclusions

RT seems to be associated with a lesser amount of estimated blood loss, better cosmetic satisfaction, and a low level of swallowing impairment, while OT was associated with a shorter operation time and more retrieved lymph nodes. Randomized clinical trials with large samples and comparative studies that reflect long-term follow-up data are needed to validate our findings.

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Acknowledgment

This study was funded by the National Evidence-based Healthcare Collaborating Agency in Korea (NC13-007).

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Authors and Affiliations

  1. National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

    Soo Kyung Son MHS, Jin Hee Kim PhD & Ja Seong Bae MD, PhD

  2. Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea

    Jin Hee Kim PhD

  3. Department of Surgery, Catholic University of Korea College of Medicine, Seoul, 137-701, Korea

    Ja Seong Bae MD, PhD

  4. Department of Nursing Science, College of Nursing, Gachon University, Incheon, 406-799, Korea

    Seon Heui Lee PhD

Authors
  1. Soo Kyung Son MHS
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  2. Jin Hee Kim PhD
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  3. Ja Seong Bae MD, PhD
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  4. Seon Heui Lee PhD
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Corresponding authors

Correspondence to Ja Seong Bae MD, PhD or Seon Heui Lee PhD.

Appendix

Appendix

See Figs. 3 and 4, and Table 4.

Fig. 3
figure 3

Study selection process. DBs databases, RT robotic thyroidectomy, OT open thyroidectomy

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Fig. 4
figure 4figure 4

Forest plot and meta-analysis of complications: a transient hypocalcemia; b permanent hypocalcemia; c transient RLN palsy; d permanent RLN palsy; e bleeding or hematoma; f chyle leakage; and g seroma. RLN recurrent laryngeal nerve, M–H Mantel–Haenszel, CI confidence interval, df degrees of freedom

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Son, S.K., Kim, J.H., Bae, J.S. et al. Surgical Safety and Oncologic Effectiveness in Robotic versus Conventional Open Thyroidectomy in Thyroid Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 22, 3022–3032 (2015). https://doi.org/10.1245/s10434-015-4375-9

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  • DOI: https://doi.org/10.1245/s10434-015-4375-9

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