Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy.
BACKGROUND
Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy.


METHODS
The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively.


RESULTS
Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups.


CONCLUSIONS
Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-792, Korea. kytae@hanyang.ac.kr
Kyung
K
Tae
Ki Yong
KY
Kim
Bo Ram
BR
Yun
Yong Bae
YB
Ji
Chul Won
CW
Park
Dong Sun
DS
Kim
Tae Wha
TW
Kim
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012371:Robotics; D016606:Thyroid Nodule / Q000503:physiopathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D014832:Voice Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D014833:Voice Quality; D055815:Young Adult