Skip to main content
Erschienen in: World Journal of Surgery 2/2018

06.09.2017 | Original Scientific Report

Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies

verfasst von: Min Jhi Kim, Kee-Hyun Nam, Seul Gi Lee, Jung Bum Choi, Tae Hyung Kim, Cho Rok Lee, Jandee Lee, Sang-Wook Kang, Jong Ju Jeong, Woong Youn Chung

Erschienen in: World Journal of Surgery | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Since the use of robot systems in thyroid surgery was introduced in 2007, we have advanced a novel method of robotic thyroidectomy (RT) using a gasless transaxillary approach (TAA). We report our experience with this technique and detail the surgical outcome of 5000 robotic thyroidectomies.

Methods

From October 2007 to May 2016, we successfully performed 5000 robotic thyroidectomies using a gasless TAA at the Department of Surgery, Yonsei University Health System. The medical records of the patients are reviewed retrospectively, and the details of clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes are analyzed.

Results

The 5000 patients with thyroid tumor (4804 with cancer and 196 with benign tumor) underwent RT using a gasless TAA. Mean operation time was 134.5 ± 122.0 min. The most common histologic subtype of thyroid cancer was papillary (98%), and the mean tumor size was 8.0 ± 6.0 mm. Stage I was found in 85.4% patients regarding tumor nodes metastasis staging. The 196 benign tumors consisted of 104 adenomatous hyperplasias (53.0%), 43 follicular adenomas (21.9%), 30 Graves’ diseases (15.3%), and 19 others (9.7%). Postoperative complication occurred in 24.1% without any serious one, and overall morbidity tended to decrease over time. No disease-specific mortality was observed during the follow-up period. Locoregional recurrence was developed in 26 patients (0.5%).

Conclusion

The authors have tried to improve RT technique using gasless TAA and achieved acceptable surgical outcomes. The rapid evolution of surgical robot technology and our constant effort to advance RT technique using gasless TAA would make it possible to reduce the perioperative morbidity and gain the best possible operative and oncologic outcomes.
Literatur
1.
Zurück zum Zitat Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRefPubMed Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875CrossRefPubMed
2.
Zurück zum Zitat Huscher CS, Chiodini S, Napolitano C et al (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877CrossRefPubMed Huscher CS, Chiodini S, Napolitano C et al (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877CrossRefPubMed
3.
Zurück zum Zitat Shimizu K, Akira S, Jasmi AY et al (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703CrossRefPubMed Shimizu K, Akira S, Jasmi AY et al (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703CrossRefPubMed
4.
Zurück zum Zitat Ikeda Y, Takami H, Sasaki Y et al (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340CrossRefPubMed Ikeda Y, Takami H, Sasaki Y et al (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340CrossRefPubMed
5.
Zurück zum Zitat Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4CrossRefPubMed Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4CrossRefPubMed
6.
Zurück zum Zitat Kang SW, Jeong JJ, Yun JS et al (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369CrossRefPubMed Kang SW, Jeong JJ, Yun JS et al (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369CrossRefPubMed
7.
Zurück zum Zitat Kang SW, Jeong JJ, Nam KH et al (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7CrossRefPubMed Kang SW, Jeong JJ, Nam KH et al (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7CrossRefPubMed
8.
Zurück zum Zitat Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406CrossRefPubMed Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406CrossRefPubMed
9.
Zurück zum Zitat Goh HK, Ng YH, Teo DT (2010) Minimally invasive surgery for head and neck cancer. Lancet Oncol 11:281–286CrossRefPubMed Goh HK, Ng YH, Teo DT (2010) Minimally invasive surgery for head and neck cancer. Lancet Oncol 11:281–286CrossRefPubMed
10.
Zurück zum Zitat Lang BH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125:509–518CrossRefPubMed Lang BH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125:509–518CrossRefPubMed
11.
Zurück zum Zitat Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefPubMed Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefPubMed
12.
Zurück zum Zitat Ryu HR, Kang SW, Lee SH et al (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211:e13–e19CrossRefPubMed Ryu HR, Kang SW, Lee SH et al (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211:e13–e19CrossRefPubMed
13.
Zurück zum Zitat Kang SW, Lee SH, Ryu HR et al (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148:1214–1221CrossRefPubMed Kang SW, Lee SH, Ryu HR et al (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148:1214–1221CrossRefPubMed
14.
Zurück zum Zitat Kang SW, Park JH, Jeong JS et al (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech 21:223–229CrossRefPubMed Kang SW, Park JH, Jeong JS et al (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech 21:223–229CrossRefPubMed
15.
Zurück zum Zitat Rivere AE, Brooks AJ, Hayek GA et al (2014) Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg 80:817–820PubMed Rivere AE, Brooks AJ, Hayek GA et al (2014) Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg 80:817–820PubMed
16.
Zurück zum Zitat Lee S, Lee CR, Lee SC et al (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075CrossRefPubMed Lee S, Lee CR, Lee SC et al (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075CrossRefPubMed
19.
Zurück zum Zitat Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:e71–e75CrossRefPubMed Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19:e71–e75CrossRefPubMed
20.
Zurück zum Zitat Tae K, Song CM, Ji YB et al (2016) Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching. Surg Endosc 30:4785–4792CrossRefPubMed Tae K, Song CM, Ji YB et al (2016) Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching. Surg Endosc 30:4785–4792CrossRefPubMed
21.
Zurück zum Zitat Cho JN, Park WS, Min SY et al (2016) Surgical outcomes of robotic thyroidectomy vs. conventional open thyroidectomy for papillary thyroid carcinoma. World J Surg Oncol 14:181CrossRefPubMedPubMedCentral Cho JN, Park WS, Min SY et al (2016) Surgical outcomes of robotic thyroidectomy vs. conventional open thyroidectomy for papillary thyroid carcinoma. World J Surg Oncol 14:181CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Kim MJ, Lee J, Lee SG et al (2017) Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31:1599–1606CrossRefPubMed Kim MJ, Lee J, Lee SG et al (2017) Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31:1599–1606CrossRefPubMed
23.
Zurück zum Zitat Park JH, Lee CR, Park S et al (2013) Initial experience with robotic gasless transaxillary thyroidectomy for the management of graves disease: comparison of conventional open versus robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 23:e173–e177CrossRefPubMed Park JH, Lee CR, Park S et al (2013) Initial experience with robotic gasless transaxillary thyroidectomy for the management of graves disease: comparison of conventional open versus robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 23:e173–e177CrossRefPubMed
24.
Zurück zum Zitat Kang SW, Lee SH, Park JH et al (2012) A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis. Surg Endosc 26:3251–3257CrossRefPubMed Kang SW, Lee SH, Park JH et al (2012) A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis. Surg Endosc 26:3251–3257CrossRefPubMed
25.
Zurück zum Zitat Lee SG, Lee J, Kim MJ et al (2016) Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc 30:3474–3479CrossRefPubMed Lee SG, Lee J, Kim MJ et al (2016) Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc 30:3474–3479CrossRefPubMed
26.
Zurück zum Zitat Lee J, Kwon IS, Bae EH et al (2013) Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98:2701–2708CrossRefPubMed Lee J, Kwon IS, Bae EH et al (2013) Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98:2701–2708CrossRefPubMed
27.
Zurück zum Zitat Lee J, Yun JH, Nam KH et al (2011) The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol 18:226–232CrossRefPubMed Lee J, Yun JH, Nam KH et al (2011) The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol 18:226–232CrossRefPubMed
Metadaten
Titel
Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies
verfasst von
Min Jhi Kim
Kee-Hyun Nam
Seul Gi Lee
Jung Bum Choi
Tae Hyung Kim
Cho Rok Lee
Jandee Lee
Sang-Wook Kang
Jong Ju Jeong
Woong Youn Chung
Publikationsdatum
06.09.2017
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 2/2018
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4209-y

Weitere Artikel der Ausgabe 2/2018

World Journal of Surgery 2/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.