Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching

Abstract

Background

Various approaches for thyroid surgery became possible with the use of robotic systems. Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. In this study, we compared the surgical outcomes of TORT and conventional open thyroidectomy (OT).

Methods

We retrospectively reviewed and compared the medical records of consecutive patients who underwent TORT or OT for thyroid carcinoma from March 2009 to January 2018. Propensity score matching using 10 clinico-pathologic factors was used to generate two matched cohorts, each composed of 186 patients.

Results

The study included 372 patients who underwent TORT (n = 186) or OT (n = 186). Mean age, tumor size, and gender were not different between both groups. The two groups showed similar surgical outcomes, except for a longer operative time for TORT. There was one patient with immediate postoperative bleeding in the TORT group. The patient underwent re-operation for hemostasis with endoscopic approach. In the OT group, one patient had wound seroma, which was treated by several rounds of needle aspiration without infection. Vocal cord palsy was present in one patient in the TORT group, which was recovered in 3 months.

Conclusions

TORT could be performed safely and had comparable surgical outcomes with OT in the selected patients. TORT may be a suitable operative alternative for patients who do not want to leave scars on the neck.

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References

  1. 1.

    Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    CAS  Article  Google Scholar 

  2. 2.

    Sung ES, Ji YB, Song CM, Yun BR, Chung WS, Tae K (2016) Robotic thyroidectomy: comparison of a postauricular facelift approach with a gasless unilateral axillary approach. Otolaryngol Head Neck Surg 154:997–1004

    Article  Google Scholar 

  3. 3.

    Yu HW, Yi JW, Seong CY, Kim JK, Bae IE, Kwon H, Chai YJ, Kim SJ, Choi JY, Lee KE (2017) Development of a surgical training model for bilateral axillo-breast approach robotic thyroidectomy. Surg Endosc 32:1360–1367

    Article  Google Scholar 

  4. 4.

    Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    CAS  Article  Google Scholar 

  5. 5.

    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406

    Article  Google Scholar 

  6. 6.

    Kim WW, Kim JS, Hur SM, Kim SH, Lee SK, Choi JH, Kim S, Lee JE, Kim JH, Nam SJ, Yang JH, Choe JH (2011) Is robotic surgery superior to endoscopic and open surgeries in thyroid cancer? World J Surg 35:779–784

    Article  Google Scholar 

  7. 7.

    Dionigi G, Bacuzzi A, Lavazza M, Inversini D, Pappalardo V, Boni L, Rausei S, Barczynski M, Tufano RP, Kim HY, Anuwong A (2016) Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video. Gland Surg 5:625–627

    Article  Google Scholar 

  8. 8.

    Anuwong A, Sasanakietkul T, Jitpratoom P, Ketwong K, Kim HY, Dionigi G, Richmon JD (2018) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications, techniques and results. Surg Endosc 32:456–465

    Article  Google Scholar 

  9. 9.

    Richmon JD, Kim HY (2017) Transoral robotic thyroidectomy (TORT): procedures and outcomes. Gland Surg 6:285–289

    Article  Google Scholar 

  10. 10.

    Lee HY, You JY, Woo SU, Son GS, Lee JB, Bae JW, Kim HY (2015) Transoral periosteal thyroidectomy: cadaver to human. Surg Endosc 29:898–904

    Article  Google Scholar 

  11. 11.

    Kim HY, Chai YJ, Dionigi G, Anuwong A, Richmon JD (2017) Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc 32:688–694

    Article  Google Scholar 

  12. 12.

    Chai YJ, Kim HY, Kim HK, Jun SH, Dionigi G, Anuwong A, Richmon JD, Tufano RP (2017) Comparative analysis of 2 robotic thyroidectomy procedures: Transoral versus bilateral axillo-breast approach. Head Neck 40:886–892

    Article  Google Scholar 

  13. 13.

    Sun GH, Peress L, Pynnonen MA (2014) Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg 150:520–532

    Article  Google Scholar 

  14. 14.

    Jackson NR, Yao L, Tufano RP, Kandil EH (2014) Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck 36:137–143

    Article  Google Scholar 

  15. 15.

    Kim BS, Kang KH, Kang H, Park SJ (2014) Central neck dissection using a bilateral axillo-breast approach for robotic thyroidectomy: comparison with conventional open procedure after propensity score matching. Surg Laparosc Endosc Percutan Tech 24:67–72

    Article  Google Scholar 

  16. 16.

    Jiang Y, Gao B, Zhang X, Zhao J, Chen J, Zhang S, Luo D (2014) Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7:101–107

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Dionigi G, Chai YJ, Tufano RP, Anuwong A, Kim HY (2018) Transoral endoscopic thyroidectomy via a vestibular approach: why and how? Endocrine 59:275–279

    CAS  Article  Google Scholar 

  18. 18.

    Baek SJ, Kwak JM, Kim J, Kim SH, Park S, Korean Association of Robotic Surgeons Study G (2018) Robotic rectal surgery in Korea: analysis of a nationwide registry. Int J Med Robot 14:e1896

    Article  Google Scholar 

  19. 19.

    Chai YJ, Kim HY, Kim HK, Jun SH, Dionigi G, Anuwong A, Richmon JD, Tufano RP (2018) Comparative analysis of 2 robotic thyroidectomy procedures: Transoral versus bilateral axillo-breast approach. Head Neck 40:886–892

    Article  Google Scholar 

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Funding

This work was supported by Korea University Grants (K1816421, K1813081).

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Correspondence to Hoon Yub Kim.

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Disclosures

Ji Young You, HoonYub Kim, Da Won Park, Hsien Wen Yang, Hong Kyu Kim, Gianlorenzo Dionigi, and Ralph P. Tufano, nor their close family members, have no conflicts of interest or financial ties to disclose.

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You, J.Y., Kim, H.Y., Park, D.W. et al. Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc 35, 124–129 (2021). https://doi.org/10.1007/s00464-020-07369-y

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Keywords

  • Propensity score matching
  • Robotic thyroidectomy
  • Transoral thyroidectomy
  • Open thyroidectomy
  • Thyroid carcinoma