Clin Exp Otorhinolaryngol.  2019 Feb;12(1):1-11. 10.21053/ceo.2018.00766.

Robotic and Endoscopic Thyroid Surgery: Evolution and Advances

• Tae K
• Ji YB
• Song CM
• Ryu J

• KMID: 2437485
• DOI: http://doi.org/10.21053/ceo.2018.00766

Abstract

To minimize surgical morbidity and neck scarring, minimally invasive thyroidectomy and robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular or transoral approaches have been developed over the past 20 years. In this article, we review the evolution of robotic and endoscopic thyroid surgery and recent advances. Among remote access approaches, the gasless transaxillary approach, bilateral axillo-breast approach, postauricular facelift approach, and transoral vestibular approach are in common use today. Each procedure has its own advantages and disadvantages. Therefore, we need to understand these advantages and limitations, and to select the appropriate method for each patient. The most significant advantage of remote access thyroidectomy is its excellent cosmesis. The complication rate is similar in patients undergoing a remote access approach and those undergoing conventional surgery if the former is performed by experienced surgeons. Operative time is significantly longer in remote access thyroidectomy. In conclusion, remote access thyroidectomy is feasible and its outcomes are comparable to those of conventional transcervical thyroidectomy in highly selected patients.

Keyword

Robotic Thyroidectomy; Endoscopic Thyroidectomy; Remote Access Thyroidectomy; Minimally Invasive Thyroidectomy; Thyroid Neoplasms

MeSH Terms

Breast
Cicatrix
Humans
Methods
Neck
Operative Time
Rhytidoplasty
Surgeons
Thorax
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy

Figure

• 

  Fig. 1. Design of incisions in various robotic/endoscopic thyroidectomies. (A) Cervical approach with CO2 insufflation. (B) Minimally invasive video-assisted thyroidectomy. (C) Anterior chest approach with CO2 insufflation. (D) Video-assisted neck surgery. (E) Axillary approach with CO2 insufflation. (F) Gasless transaxillary approach with anterior chest port. (G) Single-incision transaxillary approach. (H) Gasless unilateral axillary approach. (I) Gasless unilateral axillo-breast approach. (J) Breast approach with CO2 insufflation. (K) Axillo-bilateral breast approach with CO2 insufflation. (L) Unilateral axillo-breast approach with CO2 insufflation. (M) Bilateral axillo-breast approach with CO2 insufflation. (N) Postauricular facelift approach. (O) Transoral sublingual and vestibular approach with CO2 insufflation. (P) Transoral vestibular approach with CO2 insufflation.

• 

  Fig. 2. The gasless transaxillary approach. After creating a working space, the endoscope and tree robotic instruments are placed as shown.

• 

  Fig. 3. The bilateral axillo-breast approach with CO2 insufflation. Four skin incisions are made; two in the areola and one in each axillary area.

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  Fig. 4. The postauricular facelift approach. A 30-degree face-down endoscope and three robotic instruments, namely Maryland dissectors, Prograsp forceps and Harmonic curved shears, are inserted through the postauricular incision.

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  Fig. 5. The transoral vestibular approach with CO2 insufflation. (A) After creating a working space, a 30-degree robotic endoscope and two robotic instruments, such as bipolar Maryland forceps and monopolar scissors, are placed on either side of the endoscope. (B) Prograsp or Cardinal forceps is inserted through the right axillary port if necessary.

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