title: A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience.
abstract: BACKGROUND
  The gasless, transaxillary endoscopic thyroidectomy (GTET) offers a distinct advantage over the conventional open operation by leaving no visible neck scar, and in an attempt to improve its ergonomics and surgical outcomes, the robotically assisted thyroidectomy (RAT) was introduced. The RAT uses the same endoscopic route as the GTET but with the assistance of the da Vinci S robotic system. Excellent results for RAT have been reported, but it remains unclear whether RAT offers any potential benefits over GTET.
  
  
  METHODS
  From June to December 2009, 46 patients underwent endoscopic thyroidectomy. Of these patients, 39 had surgery without the robot (GTET) and 7 had surgery with the robot (RAT). Demographics, surgical indications, operative findings, and postoperative outcomes were compared between the two groups. All the patients were followed up for at least 6 months after surgery.
  
  
  RESULTS
  Patient demographics, surgical indications, and extent of resection were similar between the two groups. The median total procedure time was significantly longer for RAT (149 min) than for GTET (100 min; p=0.018), but the contralateral recurrent laryngeal nerve was more likely to identified in RAT (100%) than in GTET (42.9%; p=0.070). On the average, GTET needed one more surgical assistant than RAT (1 vs. 0; p<0.001). The median pain score on postoperative day 0 was significantly higher with RAT than with GTET (4 vs. 2; p=0.025) but was similar on day 1. Blood loss, hospital stay, and surgical complications were similar in the two groups.
  
  
  CONCLUSIONS
  In our early experience, adding the da Vinci S robot to GTET increased the total procedure time and resulted in a higher pain score on day 0 but eliminated the need for any surgical assistant at the time of the operation.
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong SAR, China. blang@hkucc.hku.hk
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
authors.forename: Man-Po
authors.initials: MP
authors.lastname: Chow
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011183:Postoperative Complications; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology; D061226:Recurrent Laryngeal Nerve Injuries; D012371:Robotics; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult