Robotic Thyroidectomy and Modified Radical Neck Dissection: Present and Future

Chung, Woong Youn

Abstract

Since the introduction of robotic thyroid surgery in 2007, robotic thyroidectomy has become an effective and acceptable treatment for patients with thyroid cancer. Although Conventional open thyroidectomy is safe; the operative time is short and good oncologic outcomes are attained and robotic thyroidectomy is as yet not greatly advanced, many surgeons now use the modality in routine practice. Moreover, the results of robotic thyroidectomy have generated worldwide interest in minimally invasivesurgery and have encouraged several centers in Korea and the United States to develop aims identical to those set when conventional surgery is employed; the postoperative outcomes are better and cosmetic satisfaction is improved. Robotic procedures originated from open and endoscopic thyroidectomy procedures, and advances in the field should be compared with those of conventional open and endoscopic thyroidectomy. Short- and long-term oncologic outcomes must be assessed carefully, and cosmetic results and functional outcomes, such as voice and swallowing changes, require accurate objective analysis. The clinical reports on the conduct of robotic thyroid surgery via a gasless transaxillary approach showed that robotic surgery performed by experienced specialized endocrine surgeons afforded identical or superior levels of surgical radicality and oncologic safety compared to use of conventional open or endoscopic surgery in patients with thyroid carcinoma. The short-term oncologic effectiveness of thyroid surgery is assessed by measuring serum thyroglobulin (Tg) concentration via [131I] iodine (131RI) scanning, whereas long-term effectiveness is evaluated via lack of tumor recurrence. Moreover, functional outcomes increasingly emphasize high scores on validated quality-of-life (QOL) instruments. Several large-volume centers have reported the "functional and QOL" outcomes of patients who have undergone robotic thyroidectomy. In such patients, the clinical benefits of robotic thyroidectomy include excellent cosmetic results, reduced pain, improvement in swallowing function, and low morbidity rates. From the viewpoint of surgeons, robotic surgery shortens the surgical learning curve, and causes less musculoskeletal discomfort compared with the conduct of open or endoscopic surgery. The accumulated evidence to date suggests that robotic thyroidectomy and MRND are both safe and feasible in thyroid cancer patients, and can benefit both patients and surgeons.