Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis.
BACKGROUND
Since the introduction of endoscopic techniques in thyroid surgery, several trials of endoscopic lateral neck dissection have been conducted with the aim of avoiding a long cervical scar, but these endoscopic procedures require more effort than open surgery, mainly because of the relatively nonsophisticated instruments used. However, the recent introduction of surgical robotic systems has simplified the operations and increased the precision of endoscopic techniques. We have described our initial experience with robot-assisted modified radical neck dissection (MRND) in thyroid cancer using the da Vinci S system.


METHODS
From October 2007 to October 2009, 33 patients with thyroid cancer with lateral neck lymph node (LN) metastases underwent robot-assisted thyroidectomy and additional robotic MRND using a gasless, transaxillary approach. Clinicopathologic data were analyzed retrospectively.


RESULTS
Mean patient age was 37 ± 9 years and the gender ratio (male to female) was 7:26. The mean operating time was 281 ± 41 minutes and mean postoperative hospital stay was 5.4 ± 1.6 days. The mean tumor size was 1.1 ± 0.5 cm and 20 cases (61%) had papillary thyroid microcarcinoma. The mean number of retrieved LNs was 6.1 ± 4.4 in the central neck compartment and 27.7 ± 11.0 in the lateral compartment. No serious postoperative complications, such as Horner's syndrome or major nerve injury, occurred.


CONCLUSIONS
Robot-assisted MRND is technically feasible, safe, and produces excellent cosmetic results. Based on our initial experience, robot-assisted MRND should be viewed as an acceptable alternative method in patients with low-risk, well-differentiated thyroid cancer with lateral neck node metastasis.
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Sang-Wook
SW
Kang
So Hee
SH
Lee
Haeng Rang
HR
Ryu
Kang Young
KY
Lee
Jong Ju
JJ
Jeong
Kee-Hyun
KH
Nam
Woong Youn
WY
Chung
Cheong Soo
CS
Park
D000328:Adult; D001365:Axilla / Q000473:pathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D009367:Neoplasm Staging; D012371:Robotics / Q000379:methods*; D013524:Surgical Flaps / Q000473:pathology; D013525:Surgical Instruments; D013961:Thyroid Gland / Q000033:anatomy & histology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult