Robotic Thyroidectomy

Tae, Kyung

Abstract

Conventional open thyroidectomy provides direct exposure to perform safe and quick operations with minimal morbidity and almost no mortality. However, the procedure leaves a scar on the anterior neck. Thyroid nodules are common in young women, who are interested not only in treatment of the disease but also in aesthetic results. As a result, a variety of minimally invasive techniques to minimize neck scars and surgical morbidity have been developed. The minimally invasive thyroidectomy technique includes mini open incision thyroidectomy, video assisted minimally invasive thyroidectomy, and pure endoscopic thyroidectomy. However, there are some limitations to endoscopic thyroidectomy in obtaining adequate surgical viewing angles, precisely manipulating endoscopic instruments and meticulously dissecting tissues. These limitations result from the narrow working space, two-dimensional operative views and the use of inadequate endoscopic instruments. Recently, robotic technology using the da Vinci surgical system robot has been applied to minimally invasive thyroid surgery to overcome the limitations of endoscopic thyroidectomy. The da Vinci surgical system robot provides a three-dimensional 10-12 x magnified view of the surgical area. It also provides hand-tremor filtration, fine motion scaling, and precise and multi-articulated hand-like motions. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using da Vinci surgical system robot is safe, feasible and cosmetically excellent procedure in properly selected patients. It might have an advantage in the preservation of recurrent laryngeal nerve and parathyroid gland with magnified view. However, it is more invasive than open thyroidectomy. The postoperative pain or discomfort is comparable with open thyroidectomy. The oncologic safety of robotic thyroidectomy should be verified with long-term follow-up data.