title: A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy.
abstract: BACKGROUND
  Despite its feasibility, using the da Vinci robot in remote-access thyroidectomy remains controversial. This meta-analysis compared surgical and oncological outcomes between robotic-assisted thyroidectomy (RT) and non-robotic endoscopic thyroidectomy (ET).
  
  
  METHODS
  A systematic review was performed to identify studies comparing outcomes between RT and ET. Outcomes included operating time, drain output, complications, number of central lymph nodes retrieved, and preablation stimulated thyroglobulin level. A random-effects model was used.
  
  
  RESULTS
  Six studies were eligible. Of the 3510 patients, 2167 (61.7%) underwent RT whereas 1343 (38.3%) underwent ET. Despite a higher drain output (185.8 mLs versus 173.3 mLs, P = 0.019), RT had fewer temporary recurrent laryngeal nerve injury (2.6% versus 3.3%, P = 0.035) and shorter length of hospital stay (3.4 d versus 3.5 d, P = 0.030). In terms of oncological outcomes, despite higher incidence of multicentricity and larger tumors, the number of central lymph nodes retrieved during unilateral central neck dissection in RT was significantly greater than ET (4.5 ± 2.6 and 3.4 ± 2.5, P < 0.001) whereas the preablation stimulated thyroglobulin was comparable (0.8 ng/mL versus 1.1 ng/mL, P = 0.456). However, follow-up data were relatively scarce.
  
  
  CONCLUSIONS
  Adding the robot in remote-access thyroidectomy was associated with a significantly lower risk of temporary recurrent laryngeal nerve injury and shorter length of hospital stay. However, despite achieving a comparable level of surgical completeness for low-risk differentiated thyroid carcinoma between RT and ET, this study highlighted the limitations with the current literature and the need for more prospective studies with adequate follow-up.
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong SAR, China. Electronic address: blang@hkucc.hku.hk.
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong.
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Julian Shun
authors.initials: JS
authors.lastname: Tsang
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Kai Pun
authors.initials: KP
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Central neck dissection; Endoscopic thyroidectomy; Hypoparathyroidism; Nerve monitoring; Non-robotic thyroidectomy; Papillary thyroid carcinoma; Recurrent laryngeal nerve; Robotic thyroidectomy; Total thyroidectomy