title: Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases.
abstract: OBJECTIVE
  Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures.
  
  
  METHODS
  Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII).
  
  
  RESULTS
  Although the mean operating time was significantly longer in the robotic (mean, 271.8 ± 50.2 min) than in the open group (mean, 208.9 ± 56.3 min) (P < .0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and neck dissection impairment index were also similar, but postoperative swallowing difficulties (P = .0041) and sensory changes (P < .0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (P < .0001).
  
  
  CONCLUSIONS
  Robotic TT with MRND yielded similar oncologic outcomes and safety as conventional open procedures, with similar recovery of neck and shoulder disability. However, the robot technique resulted in better QoL outcomes, including better cosmetic results and reductions in neck sensory changes and swallowing discomfort.
authors.affiliation: Department of Surgery, Eulji University College of Medicine, 139-872 Seoul, Korea.
authors.forename: Jandee
authors.initials: J
authors.lastname: Lee
authors.forename: In Soon
authors.initials: IS
authors.lastname: Kwon
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Bae
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D011788:Quality of Life; D012371:Robotics; D012720:Severity of Illness Index; D012782:Shoulder / Q000503:physiopathology; D000070599:Shoulder Injuries; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D014832:Voice Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control