Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients

• Published in: Surgical endoscopy Vol. 32; no. 2; pp. 688 - 694
• Main Authors: Kim, Hoon Yub, Chai, Young Jun, Dionigi, Gianlorenzo, Anuwong, Angkoon, Richmon, Jeremy D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma, Follicular - surgery; Adult; Axilla - surgery; Female; Gastroenterology; Gynecology; Hepatology; Hospitals, University; Humans; Length of Stay; Medicine; Medicine & Public Health; Middle Aged; Neck Dissection - methods; Operative Time; Postoperative Complications; Proctology; Republic of Korea; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotics; Surgery; Surgical outcomes; Thyroid cancer; Thyroid Cancer, Papillary - surgery; Thyroid gland; Thyroid Neoplasms - surgery; Thyroid Nodule - surgery; Thyroidectomy - adverse effects; Thyroidectomy - methods; Republic of Korea; Transoral robotic thyroidectomy; Transoral thyroidectomy; Robotic thyroidectomy; Thyroid carcinoma
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-017-5724-5

Background Transoral thyroid surgery is an ideal method for minimally invasive thyroidectomy, as there is less flap dissection during the procedure and no postoperative scars. Nonetheless, technical obstacles have precluded the wide dissemination of this procedure. We present the surgical procedures and outcomes of transoral robotic thyroidectomy (TORT). Methods From September 2012 to June 2016, we performed TORT at Korea University Hospital. We used three intraoral ports and a single axillary port for the system’s four robotic arms. The surgical outcomes were retrospectively reviewed. Results Twenty-four female patients (mean age 39.6 ± 11.6 years; mean tumor size 1.0 ± 1.3 cm) underwent unilateral thyroid lobectomies with or without ipsilateral central neck dissection. Twenty patients had papillary thyroid carcinomas (PTC), three had benign nodules, and one had a follicular thyroid carcinoma. The mean surgical time was 232 ± 41 min; the mean hospital stay was 3.3 ± 0.8 days. The number of retrieved central lymph nodes in the PTC patients was 4.7 ± 3.2. There were no reports of transient or permanent vocal cord palsy, recurrence, or mortality during the median follow-up period of 16.8 months. Paresthesia of the lower lip and the chin due to mental nerve injury was observed in nine of the first 12 patients (six transient, three permanent), but no further reports of paresthesia were recorded after patient 12, when the locations of the intraoral incisions were modified. Conclusions TORT is feasible and safe for selected patients after technical refinements, and can be a potential alternative approach for scarless thyroid surgery.