Asit Arora1, George Garas2, Sunil Sharma2, Keerthini Muthuswamy2, James Budge2, Fausto Palazzo3, Ara Darzi4, Neil Tolley2. 1. Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: asitarora@doctors.org.uk. 2. Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. 3. Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. 4. Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK.
Abstract
INTRODUCTION: Transaxillary robotic thyroid surgery was pioneered in South Korea where cultural factors, anthropometry and remuneration favour this. Small thyroid nodules account for the majority of cases due to a national thyroid cancer screening programme. However, the technique has not been evaluated in the United Kingdom where larger thyroid nodules tend to undergo surgery in a patient population with a higher body mass index (BMI). METHODS: Long term prospective non-randomised study. Sixteen consecutive robotic hemithyroidectomy patients were compared to 16 open controls. RESULTS: There were no robotic conversions to open and no significant difference regarding pain, voice, or quality of life (QoL). In the robotic group, long term. scar cosmesis at 3 years was superior (p = 0.02) although the operative time was significantly longer (228 min vs. 85 min, p = 0.01). One patient had a transient recurrent laryngeal nerve paresis and another had temporary shoulder dysfunction. Both resolved in 4 weeks. DISCUSSION: This study highlights the considerable difference between a Western patient population compared to South East Asia. Despite this robotic thyroidectomy is feasible and safe in a UK population. CONCLUSIONS: Despite a low uptake in the UK compared to the Far East, robotic thyroidectomy represents a viable option for selected patients, achieving superior cosmesis compared with conventional thyroidectomy at the expense of time and cost. The key is careful patient selection. A randomised study is needed to establish the clinical efficacy compared to conventional surgery in this population.
INTRODUCTION: Transaxillary robotic thyroid surgery was pioneered in South Korea where cultural factors, anthropometry and remuneration favour this. Small thyroid nodules account for the majority of cases due to a national thyroid cancer screening programme. However, the technique has not been evaluated in the United Kingdom where larger thyroid nodules tend to undergo surgery in a patient population with a higher body mass index (BMI). METHODS: Long term prospective non-randomised study. Sixteen consecutive robotic hemithyroidectomy patients were compared to 16 open controls. RESULTS: There were no robotic conversions to open and no significant difference regarding pain, voice, or quality of life (QoL). In the robotic group, long term. scar cosmesis at 3 years was superior (p = 0.02) although the operative time was significantly longer (228 min vs. 85 min, p = 0.01). One patient had a transient recurrent laryngeal nerve paresis and another had temporary shoulder dysfunction. Both resolved in 4 weeks. DISCUSSION: This study highlights the considerable difference between a Western patient population compared to South East Asia. Despite this robotic thyroidectomy is feasible and safe in a UK population. CONCLUSIONS: Despite a low uptake in the UK compared to the Far East, robotic thyroidectomy represents a viable option for selected patients, achieving superior cosmesis compared with conventional thyroidectomy at the expense of time and cost. The key is careful patient selection. A randomised study is needed to establish the clinical efficacy compared to conventional surgery in this population.
Authors: Jonathon O Russell; Christopher R Razavi; Meghan E Garstka; Lena W Chen; Elya Vasiliou; Sang-Wook Kang; Ralph P Tufano; Emad Kandil Journal: J Am Coll Surg Date: 2018-12-23 Impact factor: 6.113
Authors: Christopher R Razavi; Mai G Al Khadem; Akeweh Fondong; James H Clark; Jeremy D Richmon; Ralph P Tufano; Jonathon O Russell Journal: Head Neck Date: 2018-05-13 Impact factor: 3.147