title: Comparison of surgical outcomes between endoscopic and robotic thyroidectomy.
abstract: OBJECTIVE
  Gasless transaxillary endoscopic thyroidectomy offers a distinct advantage over the conventional open operation because it leaves no visible neck scar. Indications have expanded with the development of new surgical techniques and instruments. However, because of the two-dimensional view and the nonflexible instruments, this procedure is not easily amenable for total thyroidectomy. So, robotic surgery has been introduced and offers improved visualization and dexterity. But, it remains unclear whether robotic thyroidectomy offers any potential benefits over endoscopic thyroidectomy. The aim of this present study was to determine whether robotic surgery is superior to endoscopic surgery through a comparison of surgical outcomes.
  
  
  METHODS
  Between May 2009 and February 2011, 165 patients underwent endoscopic thyroidectomy (endoscopy group) and 46 patients underwent robotic thyroidectomy (robot group). A gasless transaxillary approach was used in both groups. The two groups were compared in terms of patient characteristics, perioperative clinical results, pathologic findings, and postoperative complication.
  
  
  RESULTS
  Both patient groups were similar in terms of patient characteristics, mean number of retrieved central lymph nodes, pathological features, length of hospital stays, postoperative complication rate, and serum Tg level. However, the mean total operation time for thyroidectomy was 126.2 ± 37.84 min in the endoscopy group and 179.6 ± 44.34 min in the robot group (P < 0.001). Postoperative total drainage for lobectomy was 153.3 ± 45.64 for the endoscopy group and 179.9 ± 49.15 for the robot group (P = 0.031). Cost effectiveness is also an important consideration when evidence for predominance of two surgical techniques is lacking. The mean cost of robotic thyroidectomy was $6,655, compared with $829 for endoscopic thyroidectomy (P < 0.001). There was no significant difference in postoperative complications as hypocalcemia, recurrent laryngeal nerve injury, chyle leakage and tracheal injury in the two groups (P = 0.332).
  
  
  CONCLUSIONS
  Robotic thyroidectomy was lengthier in duration than endoscopic thyroidectomy, more costly, and associated with increased postoperative drainage with no improvement in oncologic outcomes or complication rates. Therefore our data do not support any advantage of robotic surgery over endoscopic surgery.
authors.affiliation: Department of Surgery, The Catholic University of Korea, Korea.
authors.forename: Ho
authors.initials: H
authors.lastname: Yoo
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Chae
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Kim
authors.forename: Shin Hyuk
authors.initials: SH
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
authors.forename: Sang Seol
authors.initials: SS
authors.lastname: Jung
authors.forename: Ja Seong
authors.initials: JS
authors.lastname: Bae
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012371:Robotics / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*