title: Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease.
abstract: OBJECTIVE
  This study compared postoperative technical, quality-of-life, and cost outcomes following either robotic or open thyroidectomy for thyroid nodules and cancer.
  
  
  METHODS
  PubMed, Ovid MEDLINE, EMBASE, ISI Web of Science, and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  We examined relevant controlled trials, comparative effectiveness studies, and cohort studies for eligible publications. We calculated the pooled relative risk for key postoperative complications, mean differences for operative time, and standardized mean differences for length of stay (LOS) using random effects models. Quality-of-life outcomes were summarized in narrative form.
  
  
  RESULTS
  The meta-analysis comprised 11 studies with 726 patients undergoing robotic transaxillary or axillo-breast thyroidectomy and 1205 undergoing open thyroidectomy. There were no eligible cost-related studies. Mean operative time for robotic thyroidectomy exceeded open thyroidectomy by 76.7 minutes, while no significant difference in LOS was identified. There were no significant differences in hematoma, seroma, recurrent laryngeal nerve injury, hypocalcemia, or chyle leak rates. The systematic review included 12 studies. Voice, swallowing, pain, and paresthesia outcomes showed no significant differences between the 2 approaches. The robotic cohort reported higher cosmetic satisfaction scores, although follow-up periods did not exceed 3 months and no validated questionnaires were used.
  
  
  CONCLUSIONS
  Transaxillary and axillo-breast robotic and open thyroidectomy demonstrate similar complication rates, but robotic approaches may introduce the risk of new complications and require longer operative times. Robotic thyroidectomy appears to improve cosmetic outcomes, although longer follow-up periods and use of validated instruments are needed to more rigorously examine this effect.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: Gordon H
authors: GH
authors: Sun
authors: Lilia
authors: L
authors: Peress
authors: Melissa A
authors: MA
authors: Pynnonen
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D061646:Operative Time; D010149:Postoperative Pain / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D013959:Thyroid Diseases / Q000473:pathology* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: brachial plexus injury; hemorrhage; hoarseness; hypocalcemia; hypoparathyroidism; length of stay; operative time; quality of life; recurrent laryngeal nerve injury; robotic surgery; thyroid cancer; thyroid nodule